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      Implementing Voluntary Medical Male Circumcision for HIV Prevention in Nyanza Province, Kenya: Lessons Learned during the First Year

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          Abstract

          Background

          In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention.

          Methods and Results

          This paper uses data from a health facility needs assessment (n = 81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (n = 2,675 VMMC clients) to describe Kenya's experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK's decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV.

          Conclusions

          This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya's VMMC implementation experience are likely generalizable to other African countries.

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          Most cited references7

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          Male circumcision for HIV prevention: from evidence to action?

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            • Record: found
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            Kenya demographic and health survey 2008–09

            (2010)
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              • Record: found
              • Abstract: not found
              • Article: not found

              Kenya AIDS Indicator Survey 2007: Preliminary Report

              (2008)
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2011
                4 April 2011
                : 6
                : 4
                Affiliations
                [1 ]Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, United States of America
                [2 ]Nyanza Reproductive Health Society, Kisumu, Kenya
                [3 ]Impact Research and Development Organization, Kisumu, Kenya
                [4 ]Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
                [5 ]National AIDS and STI Control Programme, Nairobi, Kenya
                Johns Hopkins University Bloomberg School of Public Health, United States of America
                Author notes

                Conceived and designed the experiments: AHR EL KA JNA NM RCB. Performed the experiments: AHR EL. Analyzed the data: AHR. Contributed reagents/materials/analysis tools: AHR EL. Wrote the paper: AHR. Reviewed the entire manuscript: EL WO KA JNA NM RCB. Managed implementation of VMMC activities: EL WO.

                Article
                PONE-D-11-00417
                10.1371/journal.pone.0018299
                3070734
                21483697
                3011ce46-39ec-4d22-b36c-ecf232fc8dca
                Herman-Roloff et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                Page count
                Pages: 5
                Categories
                Research Article
                Medicine
                Epidemiology
                Disease Informatics
                Global Health
                Infectious Diseases
                Sexually Transmitted Diseases
                AIDS
                Infectious Disease Control
                Public Health
                Preventive Medicine

                Uncategorized
                Uncategorized

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