HIV Prevention Knowledge Base
Biomedical Interventions: Voluntary Medical Male Circumcision
eLearning course: Male Circumcision: Policy & Programming
This three-hour e-learning course uses reviews the evidence about the protective effect of male circumcision (MC) on HIV transmission and presents available data on the acceptability and safety of MC. It also addresses program and policy issues, such as implementation challenges, and provides policy and program guidance. Developed for health policy makers and program managers, this module focuses primarily on the public health issues related to MC. The course presents information on providing MC in both high- and low-prevalence settings. Modules include key information on commodities and supply chain management; counseling, communication, and demand generation; and the cost and impact of expanding MC on HIV incidence.
A Guide to Indicators for Male Circumcision Programmes in the Formal Health Care System
Indicators are needed to measure how an intervention or program is achieving its goals. This guide developed indicators related to creating demand for male circumcision (MC), generating supply for MC, and maximizing safer sexual behavior. When used, they can help provide feedback for managing MC programs. They developed targeted indicators for indicators for advocacy that include a strong policy component, and behavior/social change. Each indicator has a detailed description, including what the indicator is intended to measure, recommended frequency of reporting, measurement tools needed, how the data will be collected, numerators, denominators, and how the indicator can be interpreted. Countries can choose to add specific indicators to their programs, or adapt them for use.
Considerations for implementing models for optimizing the volume and efficiency of male circumcision services (MOVE)
This report outlines various considerations and options for organizing adult MMC surgical services in order to improve the efficiency and service volume while assuring a safe service of high quality. It is a guide for both program managers involved in setting up or strengthening MC services, and funders and policymakers who need to make decisions about the costing and financing of MC services.
Guidance on Engaging Volunteers to Support the Scale-up of Male Circumcision Services
Volunteer medical personnel can help respond to short-term demand for medical services that local personnel do not have the skill to perform, or the infrastructure to support demand. They also build long-term capacity in training local staff during their efforts. This guide provides information on how medical volunteers can help bring male circumcision (MC) services to scale for policy makers, program managers, professional associations and the volunteers themselves. In addition to laying out the objectives of the MC volunteer program, this document describes the roles and responsibilities of all parties involved: coordinating bodies, professional associations, implementing agencies, ministries of health, service delivery sites, and volunteers.
Traditional Male Circumcision in the Context of HIV Prevention: A WHO/UNAIDS East and Southern Africa Regional Consultation
This report summarizes the findings of a meeting on traditional male circumcision (MC), which brought together those involved in both traditional and medical MC in eastern, southern, and western Africa, as well as policymakers, government officials, and UN and non-government agency representatives and researchers. The aim was to increase understanding of traditional MC practices, promote best practice for collaboration between the health sector and traditional circumcisers, and examine ways for traditional MC to contribute to HIV prevention. It covers the challenges of improving communication between the medical community and traditional male circumcisers, improving the safety of traditional MC and building links between medical and traditional MC, each with country examples and summaries of discussions by the relevant working groups during the meeting. Individual country follow-up plans are included in the report.
PEPFAR Male Circumcision Partners’ Meeting: Commodities and Improve Coordination of Male Circumcision for HIV Prevention
This report documents what took place during a meeting among organizations working with the President’s Emergency Plan for AIDS Relief (PEPFAR) to promote and provide male circumcision (MC) as an appropriate HIV prevention strategy in certain country contexts. The first day of the meeting focused on sharing experiences, lessons learned, and challenges to implementing MC service delivery programs in the field. The second day focused on commodity and procurement issues that present a challenge to scaling up MC services. The report recommends how to improve the supply chain in order to support rapid scale-up of MC activities. In addition, meeting participants reached consensus on an essential MC kit. The report includes three lists of possible MC commodities options.
Decision Makers’ Program Planning Tool (DMPPT): Calculating the Costs and Impacts of a Male Circumcision Program
This tool is comprised of a series of spreadsheets and a manual explaining their use in estimating the costs and impact of scaling up male circumcision (MC) services. Costing information is calculated by delivery mode based on locally derived information about staff time and salaries, supplies, equipment, and shared facility and staff costs. Users can also estimate the impact of MC on a country’s HIV epidemic, including net cost per averted HIV infection. By varying coverage levels and speed of scale-up, users can examine the cost and impact of different scenarios. This tool was used to model the cost and impact of scaling up MC services in 14 eastern and southern African countries.
Male Circumcision Situation Analysis Toolkit
A situation analysis is crucial to developing safe male circumcision (MC) services. Such an analysis can help program planners (1) understand the determinants and scale of MC practices, (2) assess current capacity to perform safe MC, and (3) understand whether community support exists for MC. This toolkit contains six tools that can be used to obtain a situation analysis from which to build a successful MC program. These tools include guided desk review, key informant interviews, stakeholders’ meetings, focus groups, service availability, feedback and action.
Male Circumcision Services Quality Assessment Toolkit
This tool can be used to assess the quality of male circumcision (MC) services, guide setting up services, and improve existing services. In addition to measuring a site’s progress towards meeting standards, it can be used for certification or accreditation. It first outlines how the toolkit should be used, how often assessments should take place, and what should be done with the findings. The toolkit contains extensive checklists that can be used to assess everything from infection prevention and control to the surgical procedures taking place, counseling, and managing adverse events.
Operational Guidance for Scaling up Male Circumcision Services for HIV Prevention
This document was written to provide programmatic operational guidance to countries that want to implement and scale up male circumcision (MC) services. These recommendations can help programs bring MC services to scale safely, efficiently, and effectively. The guide contains 10 essential components for operationalizing MC services such as human resource development and social change communication. For each of these 10 components, readers can find a summary of key issues, key actions for consideration, and key tools and guidelines that can be accessed on the Internet. There are also vignettes from different country experiences launching MC efforts thus far.
Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for Decision-makers on Human Rights, Ethical and Legal Considerations
Male circumcision (MC) programs for HIV prevention have distinct human rights, ethical, and legal implications. This document contains guidance for decision-makers, program planners, and health care providers. State responsibilities that are outlined include protection and promotion of human rights; developing a legal, regulatory and policy framework; protecting and promoting the rights of the child; ensuring access to accurate information; protecting women in the context of MC; and progressively expanding access to voluntary MC services. Responsibilities of health care providers include ensuring: safety, non-discrimination in access to services, voluntary and informed consent, and respecting confidentiality. The document includes considerations related to infant, child, adolescent, adult MC, as well as special considerations to women. It is meant to be used with the companion document, UNAIDS Legal and Regulatory Self-Assessment Tool for Male Circumcision in Sub-Saharan Africa.
UNAIDS Legal and Regulatory Self-Assessment Tool for Male Circumcision in Sub-Saharan Africa
This tool can help countries “gauge how well the existing legal and regulatory framework is supporting male circumcision (MC) service scale-up for HIV prevention and indicate what changes may be required.” It is informed by health and human rights standards in international and domestic law, and reflects UNAIDS guidance on safe, voluntary, informed MC. The tool contains information on how to use it, the mix of skills and backgrounds needed for the assessment team, and provides users ways to assess MC availability, acceptability, education and counseling, how children and women are affected, and issues related to access and informed consent, among other topics. It is meant to be used with the document Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for Decision-makers on Human Rights, Ethical and Legal Considerations.
Manual for Male Circumcision under Local Anesthesia
This comprehensive manual describes the safest and most practical methods for male circumcision (MC) in resource-limited settings. It starts by describing the benefits and risks of MC, and how MC can be linked to other sexual and reproductive health services. The bulk of the manual provides technical guidance on the MC procedure, detailing the knowledge, skills, and attitudes providers need to safely provide different procedures. Containing multiple photos and drawings, sample consent forms, information sheets for clients, stock cards, adverse event forms that manual is an excellent training tool. In addition, the manual contains a chapter on counseling and client and obtaining informed consent for MC, infection prevention, managing complications, and running a MC service.
Initiating Community-Level Medical Male Circumcision Services in South Africa and Training Their Teams (August 2010–December 2011): Project Report
The implementation report provides details on the effort of Jerusalem’s Operation Abraham Collaborative and St. Mary’s Catholic Mission Hospital, in KwaZulu-Natal, South Africa, to roll out a medical male circumcision (MC) intervention in South Africa. Challenges and solutions are discussed. Preparing the facility was the first step in implementation, and floor plans and photos are provided. The project goal was to circumcise 50 or more men a day; therefore, an efficient patient flow had to be established. Training hospital and clinical staff on MC was the next step; a daily training schedule illustrates how this worked for the program, which trained 19 medical doctors, 53 nurses, 11 administrative personnel, and 3 counselors between August 2010 and December 2011. Educating the clients through preoperative group and individual counseling is another key program component. Measures for quality assurance and sustainability are included. Finally, program details for participating hospitals are provided.