Background: Tanzania''s voluntary medical male circumcision (VMMC) program reached over 2.5 million males in regions with low male circumcision coverage and high HIV prevalence. Modeling, using the Decision Makers'' Program Planning Toolkit 2, indicates many scale up districts are approaching 80% male circumcision coverage. Sauti, a PEPFAR/USAID-funded project in Tanzania, offers community-based combination prevention services, including HTS, to key and vulnerable populations (KVP), including mobile men and partners of female sex workers, and refers HIV negative, uncircumcised men to VMMC services.
Methods: We reviewed program data across ten Sauti regions between August 2015 and September 2017 to determine circumcision prevalence for men served by HTS. We reviewed HIV negative male clients and their self-reported circumcision status. Further analysis was conducted determining their resident or non-resident status of region where they received HTS (as a proxy for mobility). A two-population proportions z-test was used to compare the region prevalence of circumcision between 2015 Tanzania Demographic Health Survey and Sauti.
Results: Among 578,126 men reached through HTS, 533,371
(92.3%) responded to the question about past circumcision, and 55.6% reported being circumcised. HIV negative men reached by Sauti''s program self-reported circumcision at much lower rate compared to the 2015 TDHS circumcision prevalence in 9 of the 10 regions Differences were statistically significant (p< 0.001). The three regions with the largest differences between Sauti and TDHS estimates (Dodoma 51% vs 100%, Morogoro 41% vs. 99%, Dar es Salaam 60% vs. 93%, respectively) are all considered ''traditionally circumcising'' regions; they do not have VMMC programming. Further analyses of uncircumcised men receiving HTS in these three regions indicated that 35% on average were non-resident, indicating that they had recently moved.
Conclusions: Given discrepancies in circumcision prevalence, further investigation is warranted to determine why a substantial proportion of uncircumcised males are presenting for HTS in regions where circumcision is considered nearly universal according to TDHS, and whether this is due to the mobility of these men. Community-based HTS are reaching large numbers of uncircumcised HIV negative men, suggesting a potential role for direct provision of adult circumcision services in combination prevention package in regions not typically served by VMMC programs.



[Table 1. Circumcised versus uncircumcised men by region, Sauti versus TDHS]

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