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UPDATE ON MALE CIRCUMCISION IN UGANDA

UPDATE ON MALE CIRCUMCISION IN UGANDA. Dr. Jackson Amone Uganda MC-NTF Secretariat Presention at Arusha, Tanzania from 8 th – 10 th June, 2010. Background. Total population of Uganda is 32 million (UBOS 2009 Projection) HIV prevalence: 6.4% MC Prevalence 25% (Source: UHSBS 2004/05)

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UPDATE ON MALE CIRCUMCISION IN UGANDA

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

  2. 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

  3. MC Prevalence in Uganda (2004/05) 3

  4. Uganda with generalized HIV epidemic 2.3% 8.2% Uganda total: 6.4 3.5% Benefit of MC higher in generalized epidemic especially when MMC prevalence is low 5.3% 6.5% 6.9% 8.5% Kampala – 8.5% 5.9%

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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 8th 2009-March 10th, 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

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