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Catching Up through Improved Voluntary Medical Male Circumcision (VMMC) Campaigns: Lessons from Zambia

by: Webby Kanjipite1, Mainza Lukobo-Durrell2, Joseph Nikisi1, Jackson Okuku1, Makawa D. Daniel3 and Kwame Asiedu1 affiliate: 1Jhpiego, an affiliate of Johns Hopkins University/Zambia, 2Jhpiego, an affiliate of Johns Hopkins University/USA, 3Ministry of Health, Zambia

Background Information n Zambia has a total population of 13.3


n National adult HIV prevalence rate is n MC prevalence ranges from 3.2% to
million (2010 Census). 14.3% (Zambia Demographic and Health Survey, 2007). 71%, though with very wide variations between provinces (CSO and Macro International, 2009).

Description of Interventions n 2010 and 2011 campaigns used the


following strategies: n Deployment of trained providers for n Enhanced onsite supportive
supervision equipment VMMC and HIV testing and counseling (HTC), and surgery

What Was Done Differently in 2012?


Jhpiego Zambia VMMC success

Jhpiego-specific factors

National-level factors

n Provision of adequate supplies and n Support in data management

80% 70% 60% 50% 40% 30% 20% 10% 0


rn er n er n tra ka rb e ul he te en or th ap st sa W es Ea Lu pe ut es te rn rn l a lt C Lu So w

MC Prevalence

HIV Prevalence

n 2012 campaign also featured:

Jhpiego-Specific Factors
Early preparation

n A focus on efficiencies including a

combination of service delivery models (outreach and static sites) areas with high demand

n Review of previous MC data to locate n Introduction of pre-packed VMMC


supplies and consumables kits
Increase in the technical staff

BASIS OF SUCCESS

National Commodity Agency

n Intensified advocacy via mass media

and high-level advocacy through traditional chiefs, political leaders and active MOH leadership

Political will and support in the office

Campaign strategy

op

n Routine data from 2010 to 2012 were

Provinces

n VMMC was included as part of

n Dramatic scale-up was needed for the

comprehensive HIV prevention and treatment programs by the Government of the Republic of Zambia (Operational Plan, 2012). country to achieve VMMC coverage of 80% among the targeted group by 2015 to maximize the public health benefit in regard to HIV prevention.

n Since December 2009, 65,927 MCs have


been conducted in Jhpiego-supported sites; of these, 50% were done during VMMC campaign periods. campaigns, 5,493 and 5,283 VMMCs were conducted respectively, contributing about 20% toward the national targets for 2011.

analyzed retrospectively; total numbers of clients circumcised were compared by the campaign modes that were used each year.

National Factors n Intensified advocacy via mass media:


and advertisements

or th

n National and local radio, TV talk shows

n High-level advocacy by:


n Minister of Health n Traditional chiefs n Other political leaders

n During the August 2010 and 2011

n Active MOH leadership:

n Instruction from Permanent Secretary

Results n With improved campaign strategies,

n This exceeded the set target of 16,000 n Jhpiego contributed 36% toward the
national figure for 2012. adverse events.

the number of VMMCs conducted at Jhpiego-supported sites in the August 2012 campaign was four times higher (22,590) than the numbers in the 2010 (5,493) and 2011 (5,283) campaigns. MCs during the 2012 VMMC campaign.

to Provincial Medical Officers, District Medical Officers and Facility Managers to work closely with partners and release health workers for the campaign

Next Steps and Recommendations n Rapidly scaling up and increasing

n Key components needed to sustain

access to and coverage of VMMC services require continued use of more efficient campaigns with a variety of service delivery models. a successful campaign include a combination of diverse demand creation strategies, involving the media and advocacy of traditional and political leaders, and MOH leadership and support.

To Achieve Universal Coverage, Zambia Needs to Reach 1.949 Million HIV-Negative Adult Males by 2015
868,538 526,818 84,604 2011 198,511 2012 270,528 2013 2014 2015 Annual VMMCs decrease in 2016 126,463 2016 Sustainability phase

n Less than 2% of clients had reported n Almost 80% of clients had been tested
for HIV during VMMC campaigns.

Results: Performance Comparison of Three VMMC Campaigns


25,000

References

87%

88%

Catch-up phase

86%

Number of VMMCs done during campaigns

20,000 84%

Source: MOH, 2012.

Expected impact in Zambia: 339,632 HIV infections (29.9%) averted US$1.7 billion in savings (20112025)

80% 10,000

78%

78%

76% 5,000

Purpose n Improving the organization of VMMC

74%
2010 2011 2012

74%

72%

n Jhpiego and other partners have been

campaigns has increased access to and coverage of VMMC services over the last 3 years (2010, 2011 and 2012). supporting the Ministry of Health (MOH) with annual VMMC campaigns at MOH health facilities:

MCs

Counseling and Testing

n Designed to create demand

This work has been supported by the Presidents Emergency Plan for AIDS Relief (PEPFAR) through the Cooperative Agreement Number 3U2GPS001414 from the U.S. Centers for Disease Control and Prevention (CDC). The opinions expressed herein are those of the authors and do not necessarily reflect the views of PEPFAR, CDC or the United States Government.

% of MC clients receiving HTC

15,000

82%

1. Central Statistical Office (CSO) [Zambia] and Macro International, Inc. 2009. Zambia Demographic and Health Survey 2007: Key Findings. Calverton, Maryland, USA: CSO and Macro International, Inc. 2. Ministry of Health (MOH). 2012. Country Operational Plan for the Scale-Up of Voluntary Medical Male Circumcision in Zambia, 20122015. http://www. malecircumcision.org/country_updates/ documents/Zambia_VMMC_operational_plan. pdf. Accessed on June 12, 2013. 3. World Health Organization. 2007. New data on voluntary medical male circumcision and HIV prevention: policy and programme implications. http://www.malecircumcision. org/advocacy/documents/WHO_UNAIDS_ New_Data_MC_recommendations. Accessed on June 12, 2013.