Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania
The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency—including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing—the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.
Vyšlo v časopise:
Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania. PLoS Med 8(11): e32767. doi:10.1371/journal.pmed.1001131
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Review
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001131
Souhrn
The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency—including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing—the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.
Zdroje
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2. BaileyRCMosesSParkerCBAgotKMacleanI 2007 Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 369 643 656
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6. World Health Organization 2010 Considerations for implementing models for optimizing the volume and efficiency of male circumcision services for HIV prevention. Geneva World Health Organization
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8. Tanzania National Institute for Medical Research, Tanzania Ministry of Health and Social Welfare 2009 Situation analysis for male circumcision in Tanzania: final report. Dar es Salaam (Tanzania): National Institute for Medical Research. Available: http://malecircumcision.org/programs/documents/TanzaniaMaleCircumcisionSituationAnalysis_September_09.pdf. Accessed 1 November 2011
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10. NjeuhmeliEForsytheSReedJOpuniMBollingerL 2011 Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS Med 8 e1001132 doi:10.1371/journal.pmed.1001132
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12. PlotkinMKüverJCurranKMzirayHPrinceJ 2011 Embe Halijamenywa: the unpeeled mango. A qualitative assessment of views and preferences concerning voluntary medical male circumcision in Iringa Region, Tanzania. Available: http://www.mchip.net/sites/default/files/The%20Unpeeled%20Mango%20-%20Final%20Report%202011.pdf. Accessed 25 October 2011
13. Maternal and Child Health Integrated Program/Tanzania 2010 Male circumcision service delivery data from Iringa region, November 2009 to May 2010. Dar es Salaam (Tanzania) Jhpiego
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2011 Číslo 11
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