Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges

Bershteyn, Anna; Mudimu, Edinah; Platais, Ingrida; Mwalili, Samuel; Zulu, James Exnobert; Mwanza, Wiza N; Kripke, Katharine

doi:10.1007/s11904-022-00639-5

Cited by 13 publications

(9 citation statements)

References 99 publications

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“…Voluntary medical male circumcision (VMMC) is one of the most successful biomedical prevention strategies to reduce HIV transmission risk [1,2]. VMMC is also safe with reported rates of combined moderate and severe adverse events (AEs) in large VMMC programs operating at scale in Southern Africa below 2% [3][4][5][6][7], meaning that 98% of VMMC clients likely heal without any incident.…”

Section: Introductionmentioning

confidence: 99%

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Mukora

Ndebele

et al. 2023

Preprint

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Introduction Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa (SA). However, up to 98% of VMMC clients heal without adverse events (AEs). With demonstrated VMMC safety across global programs, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications per year. As part of a randomized controlled trial (RCT) to test two-way texting (2wT) follow-up as compared to routine, in-person visits for adult VMMC clients, the objective of this study was to compare costs of 2wT-based telehealth to routine post-VMMC care in both rural and urban SA settings. Methods We used an activity-based costing (ABC) approach to estimate the costs in post-VMMC care, including counselling, follow-ups, and tracing activities. All costs were estimated in $US dollars for both 2wT and routine care to test the hypotheses that 2wT follow-up would result in per-client cost savings. Data were collected from routine National Department of Health VMMC forms, the RCT database, and time-and-motion surveys. Sensitivity analysis presents different scale-up scenarios. Results We included 1,084 clients: 537 in routine care and 547 in 2wT. Average client follow-up cost is $6.48 for routine care and $4.25 for 2wT. 2wT saved costs in both rural and urban locations. Average savings of $2.23 was greater in rural ($1.61) than urban areas ($0.62). 2wT would save $0.88, $2.23, and $4.93, respectively, if: men attended one visit; men attended visits in similar proportions to that observed in the RCT; and men attended both visits. Conclusion 2wT reduces post-VMMC care costs by supporting most men to heal at home while using telehealth to triage clients with potential AEs to timely, in-person care. 2wT savings are higher in rural areas. Scale-up of 2wT-based follow-up could significantly reduce overall VMMC costs while maintaining service quality.

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Section: Introductionmentioning

confidence: 99%

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Mukora

Ndebele

et al. 2023

Preprint

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“…Voluntary medical male circumcision (VMMC) is effective in reducing the risk of HIV transmission (female-to-male by approximately 60% 1 and male-to-male by approximately 23% 2 ) and offers lifelong risk reduction for HIV transmission 3 . The WHO and UNAIDS recommend VMMC as a core HIV-prevention strategy, setting a target of 90% coverage for VMMC in high-priority countries, including South Africa 4 .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of four interventions using behavioural economics insights to increase demand for voluntary medical male circumcision in South Africa through the MoyaApp: A quasi-experimental study

Mistri,

Tomescu,

Bokolo

et al. 2024

Preprint

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Background Voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission by 60%, however, circumcision coverage falls short of the UNAIDS 90% target. We investigated whether behaviourally informed message framing increased demand for VMMC. Setting We included adult users of a data free application in South Africa, the MoyaApp, who viewed a form designed to generate interest in VMMC during August-November 2022. Methods A quasi-experimental study was conducted to evaluate four MoyaApp VMMC intervention forms against the Standard of Care (SOC) form. The primary outcome was the proportion of form submissions in which users provided their contact details for further engagement. Secondary outcomes included successful contact with the user, VMMC bookings/referrals and confirmed circumcision. Chi-squared tests and ordinary least-squares regressions were used for the analysis. Results MoyaApp VMMC form viewers totalled 118,337 of which 6% submitted a form. Foot -in-the-Door form viewers were more likely (+1.3 percentage points, p<0.01) to submit a form compared to the SOC group (6.3%). Active Choice (-1.1 percentage points, p<0.01) and Reserved for You (-0.05 percentage points, p<0.05) form viewers were less likely to submit a form compared to SOC. Users submitting on Foot-in-the-Door were less likely to be booked/referred compared to SOC (-5 percentage points, p<0.05). There were no differences between the intervention and SOC forms for successful contact and circumcisions. Conclusions Message framing using behavioural insights was able to nudge men to engage with VMMC services, however, more work is needed to understand how to convert initial interest into bookings and circumcisions.

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“…[2] The key benefits of VMMC have been summarised as reduction of individual HIV risk, reduction of community HIV risk, and reduction in incidence of STI and urological infections. [3] VMMC is implemented by trained health professionals through surgical and nonsurgical techniques. [4] Surgically, a cut is made around the head of the penis to remove the foreskin while the nonsurgical procedure involves a ShangRing placed on the penis for seven days; the skin slowly disconnects and is removed with the ShangRing.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and perceptions of voluntary medical male circumcision among University of Juba students, South Sudan

Alier,

Cham,

Majok

et al. 2024

SSMJ

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Introduction: Voluntary medical male circumcision (VMMC) is one of the key interventions against heterosexual spread of HIV. However, its prevalence in South Sudan is not clearly understood. This study aimed to assess the prevalence and perceptions of VMMC among University of Juba students.Method: A cross sectional descriptive study design was adopted. Data from randomly selected students from six schools of the University of Juba were collected using a respondent-administered structured questionnaire. IBM SPSS Statistics version 23.0 was used for data analysis. Chi-squared tests were performed to determine variables significantly associated with VMMC.Results: Amongst 390 students interviewed, the prevalence of VMMC was 41.8% and the overall male circumcision rate was 83.8%. Most respondents expressed positive attitudes and perceptions towards VMMC. The respondents believe VMMC is an important health programme. The decision to get circumcised is associated with age, marital status, religion and state of origin (p<0.001).Conclusion: Most participants were circumcised and perceive VMMC positively. A countrywide study and scale up of the current VMMC programme are recommended.

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Understanding the Evolving Role of Voluntary Medical Male Circumcision as a Public Health Strategy in Eastern and Southern Africa: Opportunities and Challenges

Cited by 13 publications

References 99 publications

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa

Evaluation of four interventions using behavioural economics insights to increase demand for voluntary medical male circumcision in South Africa through the MoyaApp: A quasi-experimental study

Prevalence and perceptions of voluntary medical male circumcision among University of Juba students, South Sudan

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