Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South AfricaReport as inadecuate




Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa - Download this document for free, or read online. Document in PDF available to download.

Background

Epidemiological data from South Africa demonstrate that risk of human immunodeficiency virus HIV infection in males increases dramatically after adolescence. Targeting adolescent HIV-negative males may be an efficient and cost-effective means of maximising the established HIV prevention benefits of voluntary medical male circumcision VMMC in high HIV prevalence–, low circumcision practice–settings. This study assessed the feasibility of recruiting male high school students for VMMC in such a setting in rural KwaZulu-Natal.

Methods and Findings

Following community and key stakeholder consultations on the acceptability of VMMC recruitment through schools, information and awareness raising sessions were held in 42 high schools in Vulindlela. A three-phase VMMC demand-creation strategy was implemented in partnership with a local non-governmental organization, ZimnadiZonke, that involved: i community consultation and engagement; ii in-school VMMC awareness sessions and centralized HIV counselling and testing HCT service access; and iii peer recruitment and decentralized HCT service access. Transport was provided for volunteers to the Centre for the AIDS Programme of Research in South Africa CAPRISA clinic where the forceps-guided VMMC procedure was performed on consenting HIV-negative males. HIV infected volunteers were referred to further care either at the CAPRISA clinic or at public sector clinics. Between March 2011 and February 2013, a total of 5165 circumcisions were performed, the majority 71% in males aged between 15 and 19 years. Demand-creation strategies were associated with an over five-fold increase in VMMC uptake from an average of 58 procedures-month in initial community engagement phases, to an average of 308 procedures-month on initiation of the peer recruitment–decentralized service phase. Post-operative adverse events were rare 1.2%, mostly minor and self-resolving.

Conclusions

Optimizing a high volume, adolescent-targeted VMMC program was feasible, acceptable and safe in this setting. Adaptive demand-creation strategies are required to sustain high uptake.



Author: Carl Montague , Nelisiwe Ngcobo, Gethwana Mahlase, Janet Frohlich, Cheryl Pillay, Nonhlanhla Yende-Zuma, Hilton Humphries, Rachae

Source: http://plos.srce.hr/



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