From 22-27 July, the XIX International AIDS Conference is being held in Washington, DC, with an expected 20,000 delegates from nearly 200 countries in attendance. Convened by the International AIDS Society, this six-day meeting will bring together leaders in the fight against HIV to “translate recent momentous scientific advances into action that will address means to end the epidemic, within the current context of significant global economic challenges.” Daily highlights and a live webcast are available at the conference website.

In honor of the event, below is one of a series of blogs from our MCHIP experts in HIV and infectious diseases discussing the Program’s work to “turn the tide” on this pandemic. Other blogs in this series are:

Kenya: Using an Adaptation of RED Approach to Increase Uptake of PMTCT Services
 
Two Birds With One Stone: Integrating Maternal Health Services to Tackle Both TB and HIV

Integrating Services in Ethiopia: More Access for Mothers, Less HIV Infections in Newborns

100,000 Men and Counting: Scaling up Voluntary Medical Male Circumcision to Prevent the Spread of HIV in Tanzania

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There was an undeniable energy and excitement as final preparations for the voluntary medical male circumcision (VMMC) campaign were completed and providers readied to open services for the first VMMC campaign ever to be held in Malawi. Following training and mentoring by MCHIP, the providers were confident that they would be able to meet the demand for services.  The client turn out did not disappoint.

In collaboration with the Ministry of Health and the USAID mission, MCHIP organized a VMMC campaign in Mulanje district in the catchments areas of Chonde Health Center in Traditional Authority (TA) Mthilamanja, Muloza Health Center in TA Njema and Mulanje District Hospital in TA Mabuka. Unmet demand in hard to reach areas became so high, in fact, that another site was opened during the second week of the campaign at Kambenje health center in TA Mkanda in Mulanje District.

Working nine hours a day, six days a week for four weeks, the MCHIP-trained providers circumcised 4,348 men. HIV testing uptake was high, with 4,237 (97.4%) clients agreeing to be tested. Of these, 2.1% (n=88) clients tested HIV positive. Men in the 15-24 age group (59.8%) constituted the greatest proportion of men receiving VMMC. The overall adverse event rate (for moderate to severe adverse events) was less than 1%.

All the sites provided a minimum package of counseling, HIV testing and VMMC. In addition, there was follow up of clients at 48 hours post operation (64.4% returning for follow-up), and seven days (32.7% return for follow-up) post operation.

However, the success of the campaign was not merely in the numbers. Unlike neighboring countries, which had embraced VMMC as an HIV prevention strategy years prior, Malawi was late to join the bandwagon due to cultural and religious misconceptions. The campaign, therefore, offered an opportunity to show that MC could be performed as a medical intervention and linked to HIV and STI prevention. The campaign was also the first of its kind in Malawi to utilize principles in surgical efficiency such as Optimizing Volume and Efficiency (MOVE). By using these principles, one circumcision team was able to circumcise four men in the time it would typically take to circumcise one man.

This efficiency is good news, as the Ministry of Health in Malawi has established 5-year district-level targets to achieve a minimum of 80% coverage for males accessing VMMC services by 2016.  Scaling up VMMC to reach 80% of adult males in Malawi by 2015 would avert more than 265,000 adult HIV infections cumulatively between 2009 and 2025, and yield a total net savings of US$1.2 billion between 2009 and 2025; however, this target also requires more than 2 million MCs to be performed, with 1.1 million MCs being done in 2012 and 2013 alone. This daunting task can only be achieved through rapid scale-up of high-intensity services with the approaches MCHIP demonstrated in Mulanje.

The initiative in Mulanje is a testimony to the fact that achieving pace and scale is possible, but can only be reached through community buy in, engagement of traditional leaders, political will and country ownership. In Malawi, according to modeling, for every 12 -14 circumcisions, one HIV infection is averted. By this math, the campaign was able to avert 334 new HIV infections, and in the coming decade will save hundreds of more lives – one circumcision at a time!


Aleisha Rozario
MCHIP Monitoring & Evaluation Advisor