Table of Contents: Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up


Image Credit: (left) Sgt. Adam Fischman, US Army Africa & (right) Sterling Riber, MFDI for Jhpiego/Tanzania.
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With new HIV infections in Sub-Saharan Africa occurring at a rate of 2.3 million each year, this new Collection, featuring research published in PLOS Medicine and PLOS ONE, presents interim results from a large public health intervention of voluntary medical male circumcision (VMMC) performed by health care practitioners in low-resource settings to prevent new infections.

The Collection examines lessons learned from the scaled-up VMMC program since 2008. Research papers focus on programs in Kenya, South Africa, Tanzania, Zimbabwe and Lesotho, identifying strengths and challenges in key program areas, including demand creation, the quality of surgical services, operational efficiencies, data collection and cost controls.

The VMMC program faces challenges at multiple levels, such as maintaining quality of services while rapidly scaling up, generating demand, and resource and capacity constraints. In order to accelerate scale-up and impact, the Collection authors recommendations include increasing program efficiency by identifying and prioritizing those most at risk of acquiring HIV, matching supply with demand, and exploring the role of technology.

Collection Review

Research Articles

Costs and Impacts of Scaling up Voluntary Medical Male Circumcision in Tanzania

Veena Menon, Elizabeth Gold, Ramona Godbole, Delivette Castor, Hally Mahler, Steven Forsythe, Mariam Ally, Emmanuel Njeuhmeli

Cost Drivers for Voluntary Medical Male Circumcision Using Primary Source Data from Sub-Saharan Africa

Lori Bollinger, Adebiyi Adesina, Steven Forsythe, Ramona Godbole, Elan Reuben, Emmanuel Njeuhmeli

Cost Analysis of Integrating the PrePex Medical Device into a Voluntary Medical Male Circumcision Program in Zimbabwe

Emmanuel Njeuhmeli, Katharine Kripke, Karin Hatzold, Jason Reed, Dianna Edgil, Juan Jaramillo, Delivette Castor, Steven Forsythe, Sinokuthemba Xaba, Owen Mugurungi

Systematic Monitoring of Voluntary Medical Male Circumcision Scale-Up: Adoption of Efficiency Elements in Kenya, South Africa, Tanzania, and Zimbabwe

Jane T. Bertrand, Dino Rech, Dickens Omondi Aduda, Sasha Frade, Mores Loolpapit, Michael D. Machaku, Mathews Oyango, Webster Mavhu, Alexandra Spyrelis, Linnea Perry, Margaret Farrell, Delivette Castor, Emmanuel Njeuhmeli

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

Larissa Jennings, Jane Bertrand, Dino Rech, Steven A. Harvey, Karin Hatzold, Christopher A. Samkange, Dickens S. Omondi Aduda, Bennett Fimbo, Peter Cherutich, Linnea Perry, Delivette Castor, Emmanuel Njeuhmeli

Implications of the Fast-Evolving Scale-Up of Adult Voluntary Medical Male Circumcision for Quality of Services in South Africa

Dino Rech, Alexandra Spyrelis, Sasha Frade, Linnea Perry, Margaret Farrell, Rebecca Fertziger, Carlos Toledo, Delivette Castor, Emmanuel Njeuhmeli, Dayanund Loykissoonlal, Jane T. Bertrand

Surgical Efficiencies and Quality in the Performance of Voluntary Medical Male Circumcision (VMMC) Procedures in Kenya, South Africa, Tanzania, and Zimbabwe

Dino Rech, Jane T. Bertrand, Nicholas Thomas, Margaret Farrell, Jason Reed, Sasha Frade, Christopher Samkange, Walter Obiero, Kawango Agot, Hally Mahler, Delivette Castor, Emmanuel Njeuhmeli

Provider Attitudes toward the Voluntary Medical Male Circumcision Scale-Up in Kenya, South Africa, Tanzania and Zimbabwe

Webster Mavhu, Sasha Frade, Ann-Marie Yongho, Margaret Farrell, Karin Hatzold, Michael Machaku, Mathews Onyango, Owen Mugurungi, Bennett Fimbo, Peter Cherutich, Dino Rech, Delivette Castor, Emmanuel Njeuhmeli, Jane T. Bertrand

Work Experience, Job-Fulfillment and Burnout among VMMC Providers in Kenya, South Africa, Tanzania and Zimbabwe

Linnea Perry, Dino Rech, Webster Mavhu, Sasha Frade, Michael D. Machaku, Mathews Onyango, Dickens S. Omondi. Aduda, Bennett Fimbo, Peter Cherutich, Delivette Castor, Emmanuel Njeuhmeli, Jane T. Bertrand

Voluntary Medical Male Circumcision Programs Can Address Low HIV Testing and Counseling Usage and ART Enrollment among Young Men: Lessons from Lesotho

Virgile Kikaya, Laura Skolnik, Macarena C. GarcĂ­a, John Nkonyana, Kelly Curran, Tigistu Adamu Ashengo

Attitudes, Perceptions and Potential Uptake of Male Circumcision among Older Men in Turkana County, Kenya Using Qualitative Methods

Kate Macintyre, Katherine Andrinopoulos, Natome Moses, Marta Bornstein, Athanasius Ochieng, Erin Peacock, Jane Bertrand

Barriers and Motivators to Voluntary Medical Male Circumcision Uptake among Different Age Groups of Men in Zimbabwe: Results from a Mixed Methods Study

Karin Hatzold, Webster Mavhu, Phineas Jasi, Kumbirai Chatora, Frances M. Cowan, Noah Taruberekera, Owen Mugurungi, Kim Ahanda, Emmanuel Njeuhmeli

Voluntary Medical Male Circumcision (VMMC) in Tanzania and Zimbabwe: Service Delivery Intensity and Modality and Their Influence on the Age of Clients

Tigistu Adamu Ashengo, Karin Hatzold, Hally Mahler, Amelia Rock, Natasha Kanagat, Sophia Magalona, Kelly Curran, Alice Christensen, Delivette Castor, Owen Mugurungi, Roy Dhlamini, Sinokuthemba Xaba, Emmanuel Njeuhmeli