Background: : HPTN 071 (PopART) is a 3-arm community-randomized trial in 21 communities, 12 in Zambia and 9 in South Africa, which will determine the impact of a combination prevention intervention on HIV incidence. Community HIV-care Providers (CHiPs) delivered the intervention door-to-door for 4 years, offering HIV testing, TB screening, referral to care for HIV or TB, and providing other services, including information and referral for voluntary male medical circumcision (VMMC). We analyzed VMMC uptake by men who received the intervention from 8 Zambian intervention communities.
Methods: Participants eligible for circumcision were males who were not circumcised and not known to be HIV positive. VMMC status was determined by self-report and entered electronically. Those who were not known to be HIV positive and not circumcised were referred to the health facility. CHiPs followed up referred clients a month later or during any subsequent visits to establish if they had been circumcised. During follow up those found not circumcised if still HIV negative, and expressing a willingness to be circumcised, were referred again. The data analyzed were collected from CHiPs records for the final year of the intervention (September, 2016 to September 2017).
Results: During this period, 60,274 males consented to participate in the PopART intervention, and we were able to ascertain the circumcision status of 55,722. Of these, 24,547(44.1%) were already circumcised (17.5% traditional & 82.5% medical methods). Of those not circumcised, 4,273 (13.7%) were known HIV positive leaving 26,902 who were not known to be HIV positive and uncircumcised, and therefore eligible for VMMC referral. Of those eligible, 6,549 (24.3%) accepted referral and were referred for VMMC, and of those referred, 4,739 (72.4%) were followed up at least once after referral. Among those followed up, 1,260 (26.6%) had attended a health facility for VMMC, and of those attending the health facility 1,171 (92.9%) received VMMC. Males aged between 18-24 years were more likely to be circumcised than those ≥25 years (Table 1)
Conclusions: Door to door information delivery and referral can contribute to more males taking up VMMC, but there is still a large drop-out between referral and seeking circumcision.

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