Transcript MC COUNTRY UP-DATE MEETING
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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