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Presented by Dr. Dino Rech

Implications of the fast-evolving scale-up of adult Voluntary Medical Male Circumcision for quality of services in South Africa D Rech , S Frade , A Spyrelis , L Perry, M Farrell, R Fertziger , D Castor, E Njeuhmeli , C Toledo, JT Bertrand. Presented by Dr. Dino Rech.

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Presented by Dr. Dino Rech

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  1. Implications of the fast-evolving scale-up of adult Voluntary Medical Male Circumcision for quality of services in South AfricaD Rech, S Frade, A Spyrelis, L Perry, M Farrell, R Fertziger, D Castor, E Njeuhmeli, C Toledo, JT Bertrand Presented by Dr. Dino Rech

  2. SYMMACS South Africa • SYstematicMonitoring of the voluntary Medical Male Circumcision Scale-up in Eastern and Southern Africa • Objective: Assess implementation of VMMC under actual field conditions in four countries, including South Africa. Monitor adoption of WHO six elements of efficiency. Assess quality and safety during scale-up. • Methods: Data were collected using threeinstruments during clinicians 2-day visits to sites:  Abbreviated version of the WHO Quality Assessment of facilities (WHO, 2009)  Observation and timing of VMMC procedures  Interviews with providers and site managers • Sample: Any site operational in 2011: N = 15 Sample from more than 80 operational sites in 2012: n = 40 Same 15 sites sampled in 2011 and 2012 (repeat sites); 25 new sites in 2012, with a total of 40 sites (expanded sites) *Significant differences refer to p values < 0.05

  3. Results: Table 1. Quality assessment of VMMC sites * Difference is statistically significant in both comparisons ^ Difference is statistically significant in expanded sites only

  4. Results • Challenges Drop in ‘readiness to provide services’ in expanded (not repeat sites) ie. supplies, equipment, systems etc. • Likely due to the rapid scale-up and the large number of new sites Drop in ‘quality of surgical services’ in expanded and repeat sites ie. pre- & post-operative procedures • Likely due to ‘dilution’ of skilled staff across new sites & employment of new and inexperienced staff • Successes Actual surgical technique scored the highest Almost universal adoption of 3 efficiency elements • Recommendations • Independent team to monitor program quality and reporting of AE’s • Improve supply chain systems

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