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UPDATE ON MALE CIRCUMCISION IN UGANDA. Dr. Jackson Amone Uganda MC-NTF Secretariat Presention at Arusha, Tanzania from 8 th – 10 th June, 2010. Background. Total population of Uganda is 32 million (UBOS 2009 Projection) HIV prevalence: 6.4% MC Prevalence 25% (Source: UHSBS 2004/05)

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Update on male circumcision in uganda

UPDATE ON MALE CIRCUMCISION IN UGANDA

Dr. Jackson Amone

Uganda MC-NTF Secretariat

Presention at Arusha, Tanzania from 8th – 10th June, 2010


Background
Background

  • Total population of Uganda is 32 million (UBOS 2009 Projection)

  • HIV prevalence: 6.4%

  • MC Prevalence 25% (Source: UHSBS 2004/05)

    • The proportions contributed by either traditional MC or religious related MC are not known



Update on male circumcision in uganda

Uganda with generalized HIV epidemic

2.3%

8.2%

Uganda total: 6.4

3.5%

Benefit of MC higher in generalized epidemic especially when MMC prevalence is low

5.3%

6.5%

6.9%

8.5%

Kampala – 8.5%

5.9%


Background cont
Background cont’

MC Partnerships:

  • Support partners include: WHO, UNAIDS, UNICEF, PEPFAR(USAID & CDC), FHI and Makerere University School of Public Health

  • Implementing partners include: IRCU,Health Communication Partnership, Makerere University Walter Reed project, Rakai Health Research Science project, STAR EC &E, Ministry of Defence/DOD and HIPS


Leadership
Leadership

  • MOH providing leadership, guidance and stewardship for MC

  • National Task Force for MC in place and championing MC activities

  • Development Partners especially the UN Family (UNAIDS/WHO/UNICEF/UNFPA) are providing international policy direction

  • A MC Focal Point will be appointed soon


Situation analysis
Situation Analysis

  • Situation analysis was conducted in 2008/9 to determine the acceptability and feasibility of MC promotion in Uganda completed and disseminated to stakeholders,

  • Mapping survey of MC services completed


Policy regulations
Policy & Regulations

  • The SMC Policy has been developed

  • Communication Strategy has been developed

  • The National Launch of the SMC Policy and Communication Strategy is scheduled for mid June 2010

  • Provisional legal assessment of existing policies done


Strategy operational plan
Strategy & Operational plan

  • SMC has been included in :

    • National HIV Strategic Plan developed by UAC,

    • Health Sector Strategic Plan III

    • Health Sector HIV/AIDS Strategic Plan

  • The operational plan for SMC is under development

    • In the meantime, the start up activities are being implemented


Training on smc
Training on SMC

  • Nationwide training to be initiated soon

    • Some little funding identified by WHO

  • Health workers from a select number of facilities are being trained at the Rakai Health Sciences Research Project (RHSP) and other MC projects:

    • So far, 232 surgeons, theatre nurses and counsellors have been trained in the last one & half years (Oct 8th 2009-March 10th, 2010)

    • RHSP acting as Training Centre of Excellence

  • Members of NTF trained on the application of DMPPT


Quality assurance
Quality Assurance

  • QA tools are being initiated by MOH in collaboration with Association of Surgeons in Uganda. WHO guidelines are being adapted for Uganda context

  • MC-NTF Quarterly Meetings continue to review educational materials for advocacy and providing guidance to circumcising Health facilities


Male circumcision research
Male Circumcision Research

Rakai Health Science Research Project is conducting some studies:

  • To investigate proficiency of trained clinical officers in performing MC

  • To determine safety of conducting MC without surgical gowns.,

  • Tracking of MC clients and

  • Testing of foreskins as risk factor for HIV transmission


Mc research cont
MC Research Cont’

Makerere University school of Public Health (MUSPH) did/doing:

  • A study to model the effectiveness of MC in HIV prevention

  • A study to determine whether MC is directly effective in HIV prevention among women who are partners to circumcised men


Mc service delivery
MC Service Delivery

  • Hospitals and Health Centres are providing MC services as part of the general surgery (integrated approach)

  • Makerere University Walter Reed and Rakai Health Science Research institutions are providing MC services (project mode)

    - Kayunga and Mukono districts

  • MC target estimated in the country is 2.4 million and increase MC prevalence from 25% to 40%

  • MC PEPFAR implementing projects reported 5,340 clients circumcised within 1.5 years of implementation (Oct 2008-March 2010)


Monitoring evaluation
Monitoring & Evaluation

  • Monitoring indicators MC services are being developed by NTF in collaboration with HIV/AIDS surveillance and HMIS units of MOH.

  • Infection control guidelines are in place.


Lessons learnt
Lessons learnt

  • Establishment of MC services is a process that needs support of stakeholders right from inception.

  • Coordination & collaboration of MC is critical in tapping resources & experiences from established MC projects

  • A mix of vertical & integrated approaches to MC are essential in MC roll-out


Challenges
Challenges

  • Low prevalence of MC

  • Inadequate funding for MC scale up

  • Need to remodel facilities for MC services

  • Need to decentralize training to RRH to get adequate numbers of MC trainers

  • Policy issues on Task Shifting/Sharing of MC work to/with Nurses & Clinical Officers is still being debated - will require change of regulations

  • Security of logistics and supplies for MC is still inadequate


Innovations
Innovations

  • Working with Traditional Circumcisers to minimise SMC de-campaigns,

  • Using of existing facilities to deliver MC services before full-scale up and

  • Involvement of media houses as advocates for SMC services


Way forward
Way Forward

  • Expedite development of tech. guidelines for MC

  • Launch & disseminate MC policy and communication strategy.

  • Print and disseminate advocacy materials for MC

  • Development of MC strategic plan

  • Scale up social mobilisation

  • Organize MC national training programme with support of Rakai Health Research Project and National & Regional Referral Hospitals


Way forward1
Way Forward

  • Strengthen surgical theatres and commodity security

  • Continue to build and sustain partnership for SMC

  • Integrate MC data in HMIS