Beginning in March 2020, to reduce COVID-19 transmission, the US President’s Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.

TABLE. (Continued) CDC-supported voluntary medical male circumcisions -13 countries in eastern and southern Africa, 2017-2021 Country Fiscal year* No. of VMMCs performed Annual target achieved, % Client age group, yrs, no. (%) No. (%) <15 15-29 ≥30 VMMCs performed using a device † Clients who received HIV testing at a VMMC site Clients with a positive HIV test result § Clients with postoperative follow-up within 14 days of VMMC

Purpose of Review Since 2007, voluntary medical male circumcision (VMMC) programs have been associated with substantially reduced HIV incidence across 15 prioritized countries in Eastern and Southern Africa. Drawing on the programmatic experience of global VMMC leaders, this report reviews progress made in the first 15 years of the program, describes programmatic and research gaps, and presents considerations to maximize the impact of VMMC. Recent Findings Overall, key programmatic and research gaps include a lack of robust male circumcision coverage estimates due to limitations to the data and a lack of standardized approaches across programs; challenges enhancing VMMC uptake include difficulties reaching populations at higher risk for HIV infection and men 30 years and older; limitations to program and procedural quality and safety including variations in approaches used by programs; and lastly, sustainability with limited evidence-based practices. Considerations to address these gaps include the need for global guidance on estimating coverage, conducting additional research on specific sub-populations to improve VMMC uptake, implementation of responsive and comprehensive approaches to adverse event surveillance, and diversifying financing streams to progress towards sustainability. Summary This report’s findings may help establish a global VMMC research and programmatic agenda to inform policy, research, and capacity-building activities at the national and global levels.

Background South Sudan confirmed a measles outbreak in December 2018. An investigation was conducted to assess underlying causes of the outbreak. Methods Vaccination coverage and measles surveillance data were analyzed. A suspected measles case had fever, maculopapular rash, and cough or conjunctivitis. A confirmed measles case had generalized maculopapular rash lasting &gt;3 days, a temperature &gt;38°C, and cough or conjunctivitis; or serologic confirmation (anti-measles immunoglobin M [IgM] antibody detection) in serum samples collected ≤30 days from rash onset. A confirmed rubella case tested measles IgM-negative and rubella IgM-positive. Results Nationwide, 3727 suspected measles cases were reported in 2019. Seventy-five percent of all suspected measles cases were in children aged &lt;5 years. Thirty-six percent of patients with suspected measles were admitted to the hospital, and 36 measles-related deaths were reported. Among cases, 922 (25%) were tested for measles; of these, 317 (34%) were measles IgM-positive. Among cases that tested measles IgM-negative, 149 (33%) were rubella IgM-positive. Immunization coverage for 1 dose of measles-containing vaccine (MCV) varied by state, ranging from 6% to 67%. Conclusions Measles and rubella remain public health problems in South Sudan. To reduce measles incidence, South Sudan needs to achieve &gt;95% coverage with 2 doses of MCV.