UPDATE ON MALE CIRCUMCISION IN UGANDA Dr. Jackson Amone Uganda MC-NTF Secretariat Presention at Arusha, Tanzania from 8

th

– 10

th

June, 2010

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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 2

MC Prevalence in Uganda (2004/05)

6.9% 5.9% 2.3% Uganda with generalized HIV epidemic 8.2% 8.5% Kampala 8.5% 6.5% – 3.5% 5.3% Uganda total: 6.4

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

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Background cont’

• MC Partnerships:

Support partners include:

WHO, UNAIDS, UNICEF, PEPFAR(USAID & CDC), FHI and Makerere University School of Public Health • I

mplementing 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 5

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 6

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 7

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 8

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 10

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 11

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 12

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 13

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 14

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) 15

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.

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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 17

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 18

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 19

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 20

Way Forward

• Strengthen surgical theatres and commodity security • Continue to build and sustain partnership for SMC • Integrate MC data in HMIS 21

I thank you

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