Medical Male Circumcision in KZN

1. Medical Male Circumcision in KZN 12 October 2010

2. Support KZN DOH in rapid scale up of MMC in all 11 districts Support delivery of comprehensive, safe, affordable, accessible MMC services Increase skills and capacity of health providers in provision of MMC Strengthen community structures that support implementation of an integrated MMC Service delivery model Develop standardized guidelines, SOPs, tools, methods and equipment for MMC service delivery Disseminate correct and consistent messaging around MMC Scale-up innovative and successful models of MMC service delivery in other districts and provinces. Objectives

3. Training • MatCH team of 4 doctors and 20 nurses trained in forceps guided/MOVE model • 3 sessional doctors trained @ OF • 6 DOH staff (doctors & nurses) trained @ OF • 20 M&E support staff • eThekwini: • 3 one-day trainings for 24 doctors and 300 nurses • 292 counselors trained on MMC counseling • 43 DOH M&E staff trained • On-site training @ camps/fixed sites • 104 doctors & 345 nurses observed/participated in surgical procedures* * Data from 17 camps

4. Camps • 2-day camps for males aged 14-25 during school holidays/long weekends • Recruitment through traditional leaders, local media, schools and HCWs • Screened at PHC (CT, STI, medical screening to determine eligibility & informed consent obtained) • Day 1: procedure • Day 2: social and cultural program & follow up assessment • Day 7: follow up @ PHC

5. Results • 23 camps in 11 districts since June 2010 • Supported by CHAPS, St Mary’s, SFH, Africa Centre, Zuzimpilo, BRHC • Circumcised 3648 males • 80% 15-24 years • *Adverse Events (all 2%; mod/severe < 0.5%) • Mild - 42 • Moderate -9 • Severe -2 * Data for 17 camps

8. Fixed Sites • eThekwini sites (Addington, St Aidens, PMMH, R K Khan, Wentworth, Osindisweni in process; still to set up MG, and KEH VIII, St Mary’s already functional) • Providing equipment & supplies • Support with M&E • Mentoring & HR support • All KZN Districts - Diathermies, TA, IEC

9. Technical Assistance • Support to province in developing MMC implementation plan, including target setting • TA to facilities and all district offices in setting up fixed clinics and camps • SOPs for camps and fixed clinics in process

10. Challenges • National-Provincial communication • Parallel roll-out of Tara Klamp • Multiple requests for support of camps • Set up & logistics for camps • Limited by # diathermies & kits • Power failures during camps • DOH staff availability • Data submission via DHIS & tracking follow up • Impact of strike on fixed site set up • Changes in leadership @ provincial level

11. Plans • S2S vehicles, diathermies & kits • Proposal for discretionary funds (R400 per circumcision) from treasury • Massive scale up at fixed sites in all districts – target 60,000 in 6 months • Printing & distribution of national guidelines/IEC materials • MMC program manager & staff • M&E support in all districts • Tracking 7 day follow-up • Integration of MMC into HCT program including linking with schools • MMC Train in partnership with Metrorail

12. NGIYABONGA THANK YOU