Title

Making a pivot to maximize impact: Age of clients at PEPFAR-supported voluntary medical male circumcision programs for HIV prevention, 2017

Presenter

Carlos Toledo

Authors

C. Toledo¹, S. Davis², A. Thomas³, V. Kiggundu⁴, C. Cooney⁵, D.H. Watts⁵

Institutions

¹US Centers for Disease Control and Prevention (CDC), Atlanta, United States, ²US CDC, Atlanta, United States, ³US Department of Defense, Naval Health Research Center, San Diego, United States, ⁴United States Agency for International Development, Washington, DC, United States, ⁵Office of the US Global AIDS Coordinator, Washington, DC, United States

Background: Targeting voluntary medical male circumcision (VMMC) to males 15-29 years of age maximizes immediate HIV incidence reduction. Since 2016, PEPFAR has prioritized this age group for VMMC for HIV prevention in 14 southern and eastern African countries. However, uptake has historically been higher among 10-14-year-olds, and the new age focus has raised feasibility concerns.
Description: All PEPFAR-supported programs report numbers of men circumcised by standard age bands. Data are collapsed to less than 15, 15-29, and above 30 years of age.
Lessons learned: In 2017, over 3.4 million PEPFAR-supported VMMCs were conducted. Globally, 55% of clients were over the age of 15 (see Figure 1). Of these, 87% were aged 15-29 years. Rwanda had the greatest proportion of men over 15 years (73%) while Botswana had the lowest (26%). Tanzania conducted the highest number of VMMCs among men over 15 years (373,516 VMMCs). Globally, comparing 2017 to 2016, programs increased from 1.4 million to over 1.5 million clients aged 15-29 years; ten countries saw increases. Of these, four made considerable progress in increasing this age band in comparison to 2016; 5-10% more clients were aged 15-29 years in Malawi, South Africa, Swaziland and Tanzania. Seven countries had decreases in proportion 15-29 years of age, between 5 and 34% (absolute). Trend variations were noted between implementing partners operating in the same country.
Conclusions/Next steps: While some countries and implementing partners have successfully targeted and reached increasing absolute numbers of men in the 15-29 age group, many countries saw decreases in the proportion of priority men being circumcised in comparison to 2016. Successful strategies for reaching these males within and across country programs should be broadly shared as they may be valuable to other HIV prevention interventions. As VMMC continues to scale up, countries with VMMC coverage gaps among men over 15 years will need to implement effective strategies to target these men, while countries with high coverage among this group will need to continue a shift towards younger men to maintain gains in VMMC coverage.

[Proportion of Circumcisions by Priority Age Bands, PEPFAR, 2017]