Models to increase volumes and efficiency (MOVE) in Zimbabwe's male circumcision program
Presented by Karin Hatzold (Zimbabwe).
K. Hatzold1, C. Samkange2, E. Fusire3, G.S. Dendere4, K. Kaseke1, D. Rech5, R. Dhlamini1, G. Ncube6, O. Mugurungi6
1Population Services International Zimbabwe, Harare, Zimbabwe, 2University of Zimbabwe College of Health Sciences, Harare, Zimbabwe, 3Zimbabwe Republic Police, Medical Department, Harare, Zimbabwe, 4Air Force of Zimbabwe, Medical Department, Harare, Zimbabwe, 5Population Services International, Johannesburg, South Africa, 6Ministry of Health and Child Welfare Zimbabwe, Harare, Zimbabwe
Issues: Male circumcision (MC) has been shown to reduce a man's risk of HIV acquisition by up to 60%. Mathematical modelling suggests that 750,000 new HIV infections could be averted in Zimbabwe if 80% of men are circumcised over the next seven years. This would require rapid scale-up with 1.1 million MCs performed in the peak year of scale-up. To achieve these high outputs and optimize the use of staff time, the national MC program considered several approaches to improve efficiency and reduce surgical time.
Description: After consultation, involving Zimbabwean surgeons, public health experts, program implementers and the Orange Farm research site in South Africa, the following surgical efficiency choices were considered and piloted by the national MC program: i)use of the forceps guided surgical technique; ii)pre-assembled surgical kits and iii)diathermy for hemostasis. These efficiency choices provided advantages in terms of time, safety, costs and ease to learn.To minimize operating time and reduce down-time during and between procedures, strategies to improve client flow and increase outputs were developed. A team of two doctors and three nurses are now able to serve four MC clients simultaneously and hourly outputs have increased from three to ten MCs per hour. Over seven months, 3,304 MCs were conducted at four pilot sites using this efficiency model.
Lessons learned: Standard methods of MC service delivery that ensure high outputs, cost-effectiveness and safety are important when scaling up MC as a public health intervention. Using a team of doctors and nurses dedicated to serving four clients at one time can significantly increase the number of MCs to be conducted.
Next steps: Efficiency models will be used to support the nationwide expansion of the MC services in Zimbabwe and can provide a template to replicate in other countries scaling up MC services for HIV prevention.
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