Safe Male Circumcision

VMMC PROGRAM

The government of Botswana adopted the Voluntary Medical Male Circumcision (VMMC) program in 2009 as an add-on prevention strategy for the national HIV/AIDS response. The national goal was to circumcise 80% (385 000) of HIV-negative males aged 0-49 by 2016 (National Safe Male Circumcision Strategy 2017-2022). The preliminary results of the just-ended BIAS V exercise estimate that the country is at 48 percent of the 2016 target.

Objectives of the VMMC Program:

Increase demand for VMMC services by reaching males and females with VMMC messages.

Increase VMMC services uptake among eligible males and test at least ninety-five percent (95%) of these males seeking VMMC services at static and outreach sites.

Improve the quality of VMMC service provision and postoperative clinical care at VMMC static and outreach sites

Improve the quality, timely collection, management, and utilization of performance information within the VMMC project that enables tracking of progress in achieving the project’s objectives and for planning and management of results.

Program Management

The program is coordinated by the Ministry of Health, through the National SMC Coordinating Office.

MoH has development partners such as CDC-PEPFAR, Global Fund & UNAIDS that provide support to the program.

ACHAP is the implementing partner for CDC – Botswana, and MoH

ACHAP VMMC Teams use the MoH and WHO Standards for Service Provision.

Service Delivery Cascade

Demand Creation: Involves community mobilization and referrals for VMMC

VMMC Counselling – Entails education and consenting for VMMC procedure and voluntary HIV testing.

All HIV Positive clients are linked to the ART program

Physical Assessment – Client assessment for VMMC contraindications and eligibility to undergo the VMMC procedure by trained clinicians

VMMC Procedure – Surgical removal of the foreskin by trained and experienced clinicians

Post Operation Care – Wound care, and management.

Program Activities

Service Delivery Models

Static Sites: VMMC Services are provided from the Public Health facilities, clients could easily walk drop-in/walk-in to the facility and be circumcised

Outreach Sites: ACHAP teams reach out to the communities, and remote areas such as cattle posts and farms using equipped mobile clinics for the provision of VMMC services

ACHAP has also introduced a model called Stop & Circumcise using the equipped mobile clinic. This model enhances access to any location and provides the convenience of time. This model is suitable for the arranged institution-based service provision.

Demand Creation Interventions / Approaches

ACHAP uses community-based demand–creation agents who are locals

Human Centred Design; To address individual males’ barriers and fears

Service Integration: VMMC is being offered from other programs such as STIs, OPD, ANC, Cervical Cancer, and HTS service points

Referrals by Satisfied Clients: It is commonly called Bring a Buddy system. Circumcised and satisfied clients are facilitated to bring their uncircumcised friends/colleagues.

Dissemination of messages on electronic (including social media) and print media platforms

Partnerships with social clubs, youth groups, and female/women groups

Engagement of Traditional and Religious beliefs leaders and Community Gatekeepers such as Dikgosi and VDCs

Key successes:

Contributing more than 65% of the total number of male circumcisions done in Botswana since 2009.

Minimal Adverse Event Rate, less than 2% threshold set by WHO and MoH. ACHAP is at 0.0007% as it dates back from 2009 to date.

Excellent working relationships with stakeholders across all levels; National, District, and Village level

Program Output

Reduction of new infections among males; Estimated to avert 308 new infections with every 1000 circumcisions.

Reduces the cost of the ART Program

Reduces incidences of cervical and penile cancer among women and men

Reduces incidences of STIs

Outcome

Attainment of national HIV/AIDS Epidemic control.