Background: VMMC is an evidence-based, high-impact, biomedical HIV prevention method that can reduce a man''s risk of acquiring HIV from a female sex partner by 60%. Tanzania is one of 14 VMMC priority countries, where VMMC services have been scaled-up with a goal of 90% VMMC coverage among males ages 10 to 29. From 2009 to 2015, ICAP at Columbia University, in partnership with the Tanzania''s Ministry of Health and Social Welfare, successfully implemented VMMC services in non-traditionally circumcised lake areas of Kagera and Geita regions.
Description: ICAP''s package of VMMC services included contribution to national VMMC policies and M&E tools; development of a training package for health care workers; demand generation; provision of supplies and commodities; and completion of VMMC feasibility assessments. To reach fishermen in high HIV prevalence areas on 20 Lake Victoria islands, ICAP organized mobile clinic campaigns using outreach boats and tents to perform VMMC. To generate demand within these communities, ICAP supported innovative drama groups and performances, radio announcements, and sensitization meetings with key community, religious, and political leaders. In order to ensure linkage to HIV services, ICAP also supported mobile HIV care and treatment services.
Lessons learned: From 2009-2015, ICAP supported numerous mobile campaigns and the expansion of VMMC services to nine health facilities in Tanzania''s Lake region. A total of 125,046 men received VMMC through ICAP-supported services. Over 80,176 (67%) circumcisions were conducted through mobile campaigns and 1,067 (0.8%) men were diagnosed HIV-positive and referred to care. Of the 786,310 VMMCs conducted in all of Tanzania during this period, one out of seven were supported by ICAP.
Conclusions/Next steps: Innovative, client-centered strategies were critical to reach Tanzania saturation goals in the Great Lakes region. The utilization of mobile clinics can help VMMC programs ensure that they are providing services to communities not in easy reach of healthcare facilities. In particular, combining mobile clinic models with outreach boats allow remote islands to successfully participate in time-limited health campaigns, particularly with mobile populations such as fishermen. Partnerships with health, education, public- and private-sector, community, and religious leaders are key to this strategy.