Population Services International (PSI), in partnership with JHPIEGO and the Zambia Ministry of Health (MOH), will deliver comprehensive support infrastructure for male circumcision (MC) services, following the implementation of a pilot project and confirmation of the procedure's prophylactic potential. A recent study based on a clinical trial showing male circumcision's efficacy in preventing HIV estimates that male circumcision in sub-Saharan Africa could avert 13.7 million infections and three million deaths in the next twenty years. This project will be the first in PSI to deliver this service. This pilot will develop the support infrastructure needed to provide safe, high quality MC across three types of service delivery settings. Insights gained through program implementation will help standardize training across diverse delivery sites and, as a result, facilitate a safe and rapid roll out of MC should it be determined appropriate.
The project comprises four inter-related components:
1) An MC Steering Committee headed by the Ministry of Health (MOH) will function as the regulatory authority for all MC service provision.
2) An MC Service Delivery Package is the set of approved processes and methods for high quality MC.
3) The set of MC Service Delivery Settings includes the various mechanisms to deliver the package to clients.
4) Complementary Evaluation activities intend to appraise the results of the project.
The MC Service Delivery Package will be a key result of this project. Based on the development of the Postabortion Care (PAC) service delivery model, three components comprise the MC Service Delivery Package.
1) Provision of the male circumcision procedure itself
2) Counseling and communications on HIV prevention and testing, STI evaluation and treatment, men's general reproductive health, family planning; and
3) Linkages to other reproductive health services.
This package is supported by six operational project components.
1) provider training curriculum addressing both procedures and client counseling
2) quality assurance protocols
3) comprehensive communications campaign and materials
4) reliable supply chain for MC services;
5) administrative systems; and
6) a provider network of the approved MC service.
A recent study based on a clinical trial showing male circumcision's efficacy in preventing HIV estimates that male circumcision in sub-Saharan Africa could avert 13.7 million infections and three million deaths in the next twenty years. This project will be the first in PSI to deliver this service. As UNAIDS and WHO have not yet established policies on MC, donors continue to wait to fund it. Using existing private sector clinics, public sector facilities and an improved New Start HIV/AIDS voluntary counseling facility, a franchised network of health care providers will deliver a package of high quality services. The potential for male circumcision (MC) as an AIDS prevention strategy has now been demonstrated in a large efficacy trial in South Africa. Two additional trials are currently underway in Kenya and Uganda, and it is likely that a definitive answer regarding the prophylactic potential of circumcision will be confirmed, either positively or negatively, in the next 12-24 months. If the additional two studies validate the results from the first trial, large scale roll out of circumcision will still face considerable challenges. Approximately 15% of Zambian men in urban areas and 18% in rural areas are circumcised. Circumcision is traditionally practiced in the Northwest province, where prevalence of HIV is considerably lower than the national average (9% rather than 15%). Although less than a fifth of Zambian men are circumcised, there is high awareness and acceptability of the procedure.
One of the main motivations for PSI's investment is the reasoning that, if initial success can be demonstrated, other donors will join in supporting this important, life-saving initiative. Upon successful completion of the first year pilot program, PSI projects an additional $1,650,000 in costs for expanding the MC service delivery and monitoring package into three additional countries in sub-Saharan Africa, namely, Swaziland, Lesotho and Namibia. Parties interested in supporting this project's scaling up throughout sub-Saharan Africa are encouraged to contact PSI.