Engender Healths Work on Male Circumcision PEPFAR Male

Engender. Health’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 Engender. Health. • 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

Engender. Health… • 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).

MC Funding

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.

Supply-Demand-Advocacy Model

Findings from Site Assessments – Equipment/Supplies

APHIA II Nyanza MC Service Statistics October 2008 -April 2009

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.

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 noncircumcising communities.

Male Circumcision Consortium Project • Engender. Health 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 nonphysician clinicians providing MC services. – Assessing the safety, efficacy, and cost of MC outreach services.

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

The Shang Ring MC Device

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.