Circumcision

CIRCUMCISION SECTION

The RHSP Circumcision Section comprises two major inter-connected arms- Circumcision Research Studies and Circumcision Service. While research aims at informing policy, it also provides a platform to evaluate and improve service. Service, on the other had translates the policies arrived at into practice to benefit the served communities, country and region. Our studies are categorized into Published, Completed, Ongoing, and Upcoming studies. RHSP’s Circumcision service arm comprises surgical camps, Satellite/Static clinics, Training, and Continuous Quality Improvement. The circumcision Services adhere to the Ugandan Ministry of Health policies, and Donor guidelines. STUDIES

As a novel HIV prevention re-enforcing strategy, the WHO/UNAIDS set to achieve an 80% male circumcision prevalence target by circumcising 29.1 million men in Sub-Saharan Africa (Figure 1). In response, the Ugandan Ministry of Health adopted the ambitious goal for Uganda to perform at least 4.2 million adult & adolescent male circumcisions by end of 2016, starting in 2010, with a potential to avert 428,000 new HIV infections by 2025. To effect this, implementing partners were mandated to provide technical oversight in scale up of the Safe Male Circumcision program to different regions of the country. RHSP was thus mandated to primarily oversee the service scale up in10 districts of Central & South-western Uganda, in the context of District-led Programming.

RHSP primarily oversees circumcision camp activities in 10 Districts of Central/South-western Uganda. These include: Rakai, Lyantonde, Kalungu, Mpigi, Masaka, Lwengo, Bukomansimbi, Ssembabule, Gomba, and Kiruhura. Circumcision camps tend yield high numbers in a limited period of time (10-14 days). The dorsal slit method is typically used, though device based circumcisions (such as the Prepex device) are available options for the clients.

As part of strategy to integrate Male circumcision service into the government health system, RHSP has worked with District Health Offices to establish 9 Circumcision satellite clinics at government health units in 6 of the 10 districts where RHSP serves as Implementing partner. These include 4 in Rakai (Kakuuto HCIV, Kacheera HCIII, Kyebe HCIII, Rakai Hospital); 1 in Lyantonde (Lyantonde Hospital); 1 in Lwengo (Kyazanga HCIV); 1 in Mpigi (Mpigi HCIV); 1 in Ssembabule (Sembabule HCIV); and 1 in Bukomansimbi. As at 2015, another satellite clinic could be started in Kalungu district at Kyamulibwa HCIII.

These Satellite clinics have flexible modes of operation such as adapting flexible duty schedules, specific Male circumcision days, and organizing 10-14 day circumcision camps in a way suitable to the local setting.

Clients are given a cell phone number that they can call in case of any problem after circumcision, and are advised on what to do and where to seek help. The most common adverse events are managed by the trained staff at the units. Clients with urological contraindications or adverse events that may not be managed by the unit staff are referred to RHSP for review by a program Urologist.

The government facilities are empowered to run the satellite clinics, in consideration of sustainability in the face of funding uncertainties. As at 2015, most have been handed over to the districts, but with continued reasonable logistical and technical support from RHSP. Only the satellite clinics in Rakai and Ssembabule districts remain actively run by RHSP.

Despite the challenges of competing for limited space at the units, occasional loss of some logistics, and the sometimes unavailable staff, the satellite centers are advantageous in that they enable the government health system to own the service. The service is closer, and more available to the people.

Quality in Male circumcision for HIV prevention means the ability to satisfy stated or implied needs, Performance according to standards, Conformance to requirements, Fitness for purpose or use, and Meeting the customer’s requirements

RHSP systematically improves the quality of the service by addressing the gaps between current practices and desired standards.

CIRCUMCISION SECTION

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