UPDATE ON MALE CIRCUMCISION IN UGANDA Dr Jackson

UPDATE ON MALE CIRCUMCISION IN UGANDA Dr. Jackson Amone Uganda MC-NTF Secretariat Presention at Arusha, Tanzania from 8 th – 10 th June, 2010 1

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) 3

2. 3% Uganda with generalized HIV epidemic 8. 2% 3. 5% 6. 9% 6. 5% 8. 5% Kampala 5. 9% 8. 5% – 5. 3% Uganda total: 6. 4 Benefit of MC higher in generalized epidemic especially when MMC prevalence is low 4

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 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 8 th 2009 -March 10 th, 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. 16

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 22