Service delivery interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review

Abstract

BackgroundVoluntary medical male circumcision (VMMC) remains an essential component of combination HIV prevention services, particularly in priority countries in sub-Saharan Africa. As VMMC programs seek to maximize impact and efficiency, and to support World Health Organization guidance, specific uptake-enhancing strategies are critical to identify. showed no clear trends. Interventions that increased adult men's uptake included mobile services (compared to static facilities), home-based testing with active referral follow-up, and facility-based HIV testing with enhanced comprehensive sexual education. Six acceptability studies suggested interventions were generally perceived to help men choose to get circumcised. Eleven cost studies suggested interventions create economies-of-scale and efficiencies. Three studies suggested such interventions were feasible, improving facility preparedness, service quality and quantity, and efficiencies. ConclusionsInnovative changes in male-centered VMMC services can improve adult men's and adolescent boys' VMMC uptake. Limited evidence on interventions that enhance access and acceptability show promising results, but evidence gaps persist due to inconsistent intervention definition and delivery, due in part to contextual relevance and limited age disaggregation.Service delivery interventions for VMMC uptake PLOS ONE | https://doi.org/10.

Communication-related factors influencing the uptake of voluntary medical male circumcision among men in Lilongwe Urban, Malawi

“…A study in South Africa found that when partners are counselled together with VMMC clients in educational sessions, there is an opportunity to discuss other issues, such as sexual and reproductive health (Atkins et al, 2020;Marshall et al, 2017). This finding corresponds to what one respondent in this study said, "My partner came to the clinic for testing, and the medical personnel said I needed to get circumcised to avoid contracting the disease she had" (interview with a married uncircumcised man aged 32 years).…”

“…Medical personnel are in the forefront promoting health behaviours and, for most patients, what a medical personnel says is always true and likely to be followed (While, 2015). For example, a study which surveyed South African men who were up taking VMMC services found that 83% of them reported that if it was not for the advice of the VMCC advisers, they would not have been circumcised (Atkins et al, 2020;Marshall et al, 2017). These are typical examples of an opinion leader or influential person influencing the decision of an individual on a health-related matter.…”

“…The government of Malawi together with its stakeholders developed the VMMC communication strategy to provide a direction on demand creation and roll out of VMMC countrywide (US President's Emergency Plan for AIDS Relief PEPFAR, 2017a). In some East and Southern African countries, strategies to improve VMMC uptake included one or a combination of different interventions, which could emphasise additional, restructured, or intensified information, education or communication services or more structural aspects (Atkins et al, 2020). In Malawi, the communication strategy which was extensively used was branding the VMMC campaign using a brand name "Ndife Otsogola" (we are forward thinkers) (PSI, 2014).…”

“…Most VMMC studies have focused on analysing the barriers and facilitators of VMMC uptake and have contributed towards the knowledge in designing communication strategies, but few have been undertaken to get a deep understanding of communication-related factors that influence the uptake of VMMC from an individual's perspective. According to Atkins et al (2020) interventions to improve VMMC uptake have been implemented and adopted as good practices in VMMC, but this notwithstanding their impact has not been well documented. On the demand side, there have been concerns with regard to how VMMC information is packaged to avoid misconceptions, especially among non-circumcising communities and individuals who may view such campaigns as an affront to their culture (Kenya National AIDS Control Programme, 2010).…”

A Comparison of the Prevalence of Sexually Transmitted Infections Among Circumcised and Uncircumcised Adult Males in Rustenburg, South Africa: A Cross-Sectional Study

“…These interventions include the provision of mobile circumcision services, home based HIV testing and referral services and comprehensive sex education (42). Data also suggests that these interventions are not only perceived as acceptable but are cost effective and feasible in low resource setting (42). More research is needed on innovations to improve coverage of voluntary male circumcision, as part of the package of interventions for the prevention of HIV and STIs.…”