Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa

Abstract

BackgroundEpidemiological data from South Africa demonstrate that risk of human immunodeficiency virus (HIV) infection in males increases dramatically after adolescence. Targeting adolescent HIV-negative males may be an efficient and cost-effective means of maximising the established HIV prevention benefits of voluntary medical male circumcision (VMMC) in high HIV prevalence–, low circumcision practice–settings. This study assessed the feasibility of recruiting male high school students for VMMC in such a setting in rural KwaZulu-Natal.Methods and FindingsFollowing community and key stakeholder consultations on the acceptability of VMMC recruitment through schools, information and awareness raising sessions were held in 42 high schools in Vulindlela. A three-phase VMMC demand-creation strategy was implemented in partnership with a local non-governmental organization, ZimnadiZonke, that involved: (i) community consultation and engagement; (ii) in-school VMMC awareness sessions and centralized HIV counselling and testing (HCT) service access; and (iii) peer recruitment and decentralized HCT service access. Transport was provided for volunteers to the Centre for the AIDS Programme of Research in South Africa (CAPRISA) clinic where the forceps-guided VMMC procedure was performed on consenting HIV-negative males. HIV infected volunteers were referred to further care either at the CAPRISA clinic or at public sector clinics. Between March 2011 and February 2013, a total of 5165 circumcisions were performed, the majority (71%) in males aged between 15 and 19 years. Demand-creation strategies were associated with an over five-fold increase in VMMC uptake from an average of 58 procedures/month in initial community engagement phases, to an average of 308 procedures/month on initiation of the peer recruitment–decentralized service phase. Post-operative adverse events were rare (1.2%), mostly minor and self-resolving.ConclusionsOptimizing a high volume, adolescent-targeted VMMC program was feasible, acceptable and safe in this setting. Adaptive demand-creation strategies are required to sustain high uptake.

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

“…Montague et al . describes a further school‐based intervention that used a phased approach including community engagement, VMMC awareness sessions and peer‐recruitment . Peer‐recruiters were early adopters of VMMC and were given vouchers worth $3 for cell‐phones plus other small prizes (t‐shirts, watches etc.).…”

“…The study by Montague et al . has been considered in the earlier section as the peer‐recruiter role formed part of a complex intervention with an educational component . Downs et al .…”

Early Resumption of Sex following Voluntary Medical Male Circumcision amongst School-Going Males

“…CAPRISA performed 5165 circumcisions in a 23 month period, from March 2011 to February 2013, in the Vulindlela area [7]. The 42 schools in Vulindlela targeted by CAPRISA had a total male population of 11 088 learners.…”

“…Male learners who enrolled for circumcision were purposively recruited for this study and interviewed prior to undergoing the procedure and again six weeks post circumcision. The successes and challenges faced with regards to recruitment in the VMMC drive have been well documented elsewhere [7]. …”

“…Scaling up of VMMC amongst young males before they enter a period of high risk, due to increased sexual activity, has been demonstrated to be an effective and efficient HIV prevention strategy in South Africa [7]. …”