Implementing voluntary medical male circumcision for HIV prevention in Nyanza Province, Kenya: lessons learned during the first year. 2011

Amy Herman-Roloff, and Emma Llewellyn, and Walter Obiero, and Kawango Agot, and Jeckoniah Ndinya-Achola, and Nicholas Muraguri, and Robert C Bailey
Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, United States of America. aherma2@uic.edu

BACKGROUND In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention. RESULTS This paper uses data from a health facility needs assessment (nā€Š=ā€Š81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (nā€Š=ā€Š2,675 VMMC clients) to describe Kenya's experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK's decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV. CONCLUSIONS This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya's VMMC implementation experience are likely generalizable to other African countries.

UI MeSH Term Description Entries
D007630 Kenya A republic in eastern Africa, south of ETHIOPIA, west of SOMALIA with TANZANIA to its south, and coastline on the Indian Ocean. Its capital is Nairobi. Republic of Kenya
D008297 Male Males
D011314 Preventive Health Services Services designed for HEALTH PROMOTION. Health Services, Preventive,Preventive Health,Preventive Health Care,Preventive Health Programs,Preventive Programs,Services, Preventive Health,Care, Preventive Health,Health Care, Preventive,Health Program, Preventive,Health Programs, Preventive,Health Service, Preventive,Health, Preventive,Preventive Health Program,Preventive Health Service,Preventive Program,Program, Preventive,Program, Preventive Health,Programs, Preventive,Programs, Preventive Health,Service, Preventive Health
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002944 Circumcision, Male Excision of the prepuce of the penis (FORESKIN) or part of it. Male Circumcision,Circumcisions, Male,Male Circumcisions
D003376 Counseling The giving of advice and assistance to individuals with educational or personal problems.
D003695 Delivery of Health Care The concept concerned with all aspects of providing and distributing health services to a patient population. Delivery of Dental Care,Health Care,Health Care Delivery,Health Care Systems,Community-Based Distribution,Contraceptive Distribution,Delivery of Healthcare,Dental Care Delivery,Distribution, Non-Clinical,Distribution, Nonclinical,Distributional Activities,Healthcare,Healthcare Delivery,Healthcare Systems,Non-Clinical Distribution,Nonclinical Distribution,Activities, Distributional,Activity, Distributional,Care, Health,Community Based Distribution,Community-Based Distributions,Contraceptive Distributions,Deliveries, Healthcare,Delivery, Dental Care,Delivery, Health Care,Delivery, Healthcare,Distribution, Community-Based,Distribution, Contraceptive,Distribution, Non Clinical,Distributional Activity,Distributions, Community-Based,Distributions, Contraceptive,Distributions, Non-Clinical,Distributions, Nonclinical,Health Care System,Healthcare Deliveries,Healthcare System,Non Clinical Distribution,Non-Clinical Distributions,Nonclinical Distributions,System, Health Care,System, Healthcare,Systems, Health Care,Systems, Healthcare
D006268 Health Facilities Institutions which provide medical or health-related services. Facilities, Health,Facility, Health,Health Facility
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000078329 Workforce The number of people working or available for work or service. Human Resources,Labor Supply,Manpower,Staffing,Womanpower,Human Resource,Labor Supplies,Manpowers,Staffings,Supply, Labor,Womanpowers,Workforces

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