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EngenderHealth’s Work on Male Circumcision

EngenderHealth’s Work on Male Circumcision. PEPFAR Male Circumcision Partner’s Meeting 19-20 May 2009. Paul Perchal, MA, Director, HIV/STI Program Mark Barone, DVM, MS, Senior Medical Associate. Overview of Presentation. Brief background on EngenderHealth. Service delivery:

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EngenderHealth’s Work on Male Circumcision

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  1. EngenderHealth’s Work on Male Circumcision PEPFAR Male Circumcision Partner’s Meeting 19-20 May 2009 Paul Perchal, MA, Director, HIV/STI ProgramMark Barone, DVM, MS, Senior Medical Associate

  2. Overview of Presentation • Brief background on EngenderHealth. • Service delivery: • APHIA II Nyanza MC activities, Kenya • Men As Partners (MAP) MC activities in Tanzania and South Africa • Research: • Male Circumcision Consortium Project • Shang Ring Pilot Study

  3. EngenderHealth… • U.S.-based international non-profit. • Partners with governments, institutions, communities, and health care professionals to improve the quality of health care in the world’s poorest communities. • Long history of introducing new clinical contraceptives and other reproductive health technologies in impoverished communities with limited resources. • Currently has programs in more than 25 countries (MC work in Kenya, Tanzania, and South Africa).

  4. MC Funding

  5. APHIA II Nyanza MC Activities • USAID-funded project in western Kenya. • Supports MOH, private, & faith-based facilities in introducing MC for HIV prevention at 30 sites in 4 districts. • Working at all levels of the health system. • Integrated approach to service delivery.

  6. Supply-Demand-Advocacy Model

  7. Findings from Site Assessments – Equipment/Supplies

  8. APHIA II Nyanza MC Service StatisticsOctober 2008-April 2009

  9. Tanzania and South Africa • Developed and field tested a needs assessment tool in Mwanza, Tanzania, in 2007. • Our CHAMPION Project in Tanzania is currently conducting a national survey to help assess men’s attitudes, beliefs, and practices regarding HIV prevention and gender, including MC. • Incorporates MC messages in Men as Partners (MAP) activities for PEPFAR supported HIV prevention services.

  10. Challenges in MC Service Delivery • Limitations of task shifting vs. full time dedicated MC staff. • A number of health providers lack motivation. • Initially low uptake of HIV testing at time of MC. • Unreliable supply of consumables. • Lack of specific instruments needed, instruments of poor quality or insufficient numbers for high volume. • Lack of support from some traditional leaders in non-circumcising communities.

  11. Male Circumcision Consortium Project • EngenderHealth is responsible for leading the following 3 research studies: • Assessing the human resource capacity and training needs to support MC roll-out. • Assessing the safety, efficacy, and cost of non-physician clinicians providing MC services. • Assessing the safety, efficacy, and cost of MC outreach services.

  12. The Shang Ring for MC • Developed & commercially available in China. • A published study and other data suggest good safety profile. • Benefits of the Shang Ring: • Simple design; easy to use, learn & teach • Short procedure time ( 3-10 minutes) • Minimal bleeding • Tight seal along wound • Sutureless closure; excellent cosmetic results • Design decreases risk of serious surgical errors

  13. The Shang Ring MC Device

  14. Shang Ring Pilot Study • We will examine clinical outcomes and patient satisfaction in a small sample of Kenyan men in order to assess: • Safety • Efficacy (in terms of successful circumcision) • Acceptability/satisfaction • The pilot will also lay the groundwork for a larger RCT. • Prospective, non-comparative study at one health facility. • 40-50 men seeking MC will be enrolled, undergo MC with the Shang Ring and be followed for 6 weeks.

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