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Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year

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Title: Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year
Author(s): Herman-Roloff, Amy; Llewellyn, Emma; Obiero, Walter; Agot, Kawango; Ndinya-Achola, Jeckoniah; Muraguri, Nicholas; Bailey, Robert C.
Subject(s): male circumcision HIV prevention VMMC
Abstract: Background: In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention. Methods and Results: This paper uses data from a health facility needs assessment (n = 81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (n = 2,675 VMMC clients) to describe Kenya’s experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK’s decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV. Conclusions: This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya’s VMMC implementation experience are likely generalizable to other African countries.
Issue Date: 2011-04-04
Publisher: Public Library of Science
Citation Info: Herman-Roloff, A., Llewellyn, E., Obiero, W., Agot, K., Ndinya-Achola, J., Muraguri, N., & Bailey, R. C. 2011. Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year. PLoS One., 6(4): e18299. DOI: 10.1371/journal.pone.0018299
Type: Article
Description: © 2011 Herman-Roloff et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The original version is available through the Public Library of Science at DOI: 10.1371/journal.pone.0018299.
ISSN: 1932-6203
Sponsor: Support for this study was provided by a grant to Family Health International (FHI) from the Bill & Melinda Gates Foundation to support the Male Circumcision Consortium (MCC), a partnership between FHI, University of Illinois at Chicago working closely with the Nyanza Reproductive Health Society, and EngenderHealth. The views expressed in this publication do not necessarily reflect those of the Bill & Melinda Gates Foundation or the MCC partners Grant number: 47394; ( Additional funding for service provision came from Impact Research and Development Organization, which received funding from the President’s Emergency Plan for AIDS Relief, administered through the Centers for Disease Control and Prevention (Cooperative Agreement U62PS024508;
Date Available in INDIGO: 2011-05-26

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