Title

Scaling up voluntary medical male circumcision services in Lusaka District of Zambia

Presenter

Hildah Shasulwe

Authors

H. Shasulwe¹, J. Banda², L. Aladesanmi², O. Chituwo³, H. Chirwa², N. Kasonka², A. Chipukuma², F. Mulala⁴, J. Zulu⁴, K. Asiedu², Joseph Banda1, Lola Aladesanmi1, Omega Chituwo2, Holiness Chirwa1, Niza Kasonka1, Answell Chipukuma1, Nashiol Nyirongo1, Fran

Institutions

¹Jhpiego - an affiliate of Johns Hopkins University, Health, Lusaka, Zambia, ²Jhpiego - an affiliate of Johns Hopkins University, Lusaka, Zambia, ³Centre for Disease Control, Lusaka, Zambia, ⁴Ministry of Health Zambia, Lusaka, Zambia

Background: Male circumcision (MC) prevalence in Lusaka Province is 23% and HIV prevalence is 16%; the highest in the country. 80% of the population of the province reside in Lusaka District and has thus become a target for the scale up of HIV prevention services including MC. Historically MCs in Lusaka District have been dismal in comparison to its large population with only 33% of the annual target achieved in 2016.
Description: Jhpiego is implementing a 5-year CDC funded project under PEPFAR; providing MC services to reduce HIV transmission, thereby contributing to the control of the epidemic. The project plans to increase MC coverage to 80% in its supported districts which includes Lusaka. Services were scaled up through restructuring demand creation and service delivery strategies in 2017; this included: targeted demand creation using GIS mapping data; engagement of resident community mobilizers and facility environmental technician cadres; decentralization of services to health posts through regular outreaches; a roaster of service delivery providers for continuous deployment; as well as daily MC monitoring by program managers.
Lessons learned: This approach resulted in continuous client flows and seamless service provision. A review of MC uptake in Lusaka district from routine program data shows a dramatic improvement with over 4000 MCs done quarterly since April 2017 when this approach was implemented as compared to about 1000 MCs in the previous 5 quarters of the project. The project has contributed 15.3% of the MOH annual target for Lusaka district (67,566) after 3 quarters in 2017 as compared to only a 5.5% contribution in 2016. The project also exceeded its annual COP target by 15%.
Conclusions/Next steps: The project is now consolidating the principles of this approach as part of its standard implementation procedures and scaling this approach to its other districts of operation. These successes will also be shared with relevant stakeholder groups i.e. MOH, TWGs and other implementing partners for potential use across the country.

[Scaling up Voluntary Male Medical Circumcision in Lusaka District of zambia]

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