IMPLEMENTATION OF VMMC EFFICIENCY ELEMENTS IN 4 SUB-

SAHARAN COUNTRIES: SERVICE DELIVERY & PROVIDER

ATTITUDESJT Bertrand (Tulane), D Rech (CHAPS), E Njeuhmeli (USAID),

D Castor (USAID), S Frade (CHAPS), M Loolpapit (FHI360),

M Machaku (Jhpiego), W Mavhu (ZAPP-UZ), and L Perry (Tulane)

Methodology

  Kenya South Africa

Tan-zania

Zim-babwe

# sites visited 30 15 14 14

Types of sites:--Fixed --Outreach --Mobile

 15123

 1320

 1310

 590

# providers interviewed 86 105 93 74

# VMMC procedures observed 151 122 133 140

• Kenya, South Africa, Tanzania, Zimbabwe

• Study design: observational “natural experiment”:

– Process evaluation: 2011 & 2012

• Data collection:– Observation of VMMC facilities – Observation of up to 10 VMMC

procedures per site– Interviews with VMMC providers– Compilation of monthly service

statistics & other data

• Sampling:– Kenya: 30 (of 235) randomly selected

sites in Nyanza province– S Africa, Tanzania, Zimbabwe:

• All known sites in operation: Jan 2011• Addition of new sites that become

operational in 2011

Data collection in each country:

Kenya South 

AfricaTan-zania

Zim-babwe

Multiple bed rotation

X X X

Purchases pre-bundled kits with disposable instruments

X X

Task-shifting X XTask-sharing X X X XSurgical method: forceps-guided

X X X X

Electrocautery to stop bleeding

X x

Quality and safety - positive results:• Providers in all countries adhered to the VMMC

surgical protocols – One exception: tying of surgical knot

• HIV testing and counseling is near 100% in Tanzania and Zimbabwe

– Increasing in Kenya and South Africa. • VMMC sites in all four countries scored high on the

provision of group education for HIV prevention.

Areas for improvement (in 2+ countries)• Inadequate system for registering adverse events • Lack of post exposure prophylaxis (PEP) and

guidelines for administering it in the operation theatre

• Occasional lapses in maintaining sterile operating field

• Failure among providers to conduct a post-operative review of vital signs and to use protective eye gear.

• Absence of WHO service delivery guidelines near operating theatre in VMMC sites.

Results

Adoption of efficiency elements:

Providers generally favored introduction of efficiency elements not yet in use.

4

The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP).