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Systematic Monitoring of Voluntary Medical Male Circumcision Scale-Up: Adoption of Efficiency Elements in Kenya, South Africa, Tanzania, and Zimbabwe

Author

Listed:
  • Jane T Bertrand
  • Dino Rech
  • Dickens Omondi Aduda
  • Sasha Frade
  • Mores Loolpapit
  • Michael D Machaku
  • Mathews Oyango
  • Webster Mavhu
  • Alexandra Spyrelis
  • Linnea Perry
  • Margaret Farrell
  • Delivette Castor
  • Emmanuel Njeuhmeli

Abstract

Background: SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-up, tracked the implementation and adoption of six elements of surgical efficiency— use of multiple surgical beds, pre-bundled kits, task shifting, task sharing, forceps-guided surgical method, and electrocautery—as standards of surgical efficiency in Kenya, South Africa, Tanzania, and Zimbabwe. Methods and Findings: This multi-country study used two-staged sampling. The first stage sampled VMMC sites: 73 in 2011, 122 in 2012. The second stage involved sampling providers (358 in 2011, 591 in 2012) and VMMC procedures for observation (594 in 2011, 1034 in 2012). The number of VMMC sites increased significantly between 2011 and 2012; marked seasonal variation occurred in peak periods for VMMC. Countries adopted between three and five of the six elements; forceps-guided surgery was the only element adopted by all countries. Kenya and Tanzania routinely practiced task-shifting. South Africa and Zimbabwe used pre-bundled kits with disposable instruments and electrocautery. South Africa, Tanzania, and Zimbabwe routinely employed multiple surgical bays. Conclusions: SYMMACS is the first study to provide data on the implementation of VMMC programs and adoption of elements of surgical efficiency. Findings have contributed to policy change on task-shifting in Zimbabwe, a review of the monitoring system for adverse events in South Africa, an increased use of commercially bundled VMMC kits in Tanzania, and policy dialogue on improving VMMC service delivery in Kenya. This article serves as an overview for five other articles following this supplement.

Suggested Citation

  • Jane T Bertrand & Dino Rech & Dickens Omondi Aduda & Sasha Frade & Mores Loolpapit & Michael D Machaku & Mathews Oyango & Webster Mavhu & Alexandra Spyrelis & Linnea Perry & Margaret Farrell & Delivet, 2014. "Systematic Monitoring of Voluntary Medical Male Circumcision Scale-Up: Adoption of Efficiency Elements in Kenya, South Africa, Tanzania, and Zimbabwe," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-10, May.
    • Handle: RePEc:plo:pone00:0082518
    DOI: 10.1371/journal.pone.0082518
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    References listed on IDEAS

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    1. Bertran Auvert & Dirk Taljaard & Emmanuel Lagarde & Joëlle Sobngwi-Tambekou & Rémi Sitta & Adrian Puren, 2005. "Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial," PLOS Medicine, Public Library of Science, vol. 2(11), pages 1-1, October.
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