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Progress in voluntary medical male circumcision for HIV prevention supported by the US President’s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data
  1. Stephanie M Davis1,
  2. Jonas Z Hines1,
  3. Melissa Habel1,
  4. Jonathan M Grund1,
  5. Renee Ridzon2,
  6. Brittney Baack3,
  7. Jonathan Davitte4,
  8. Anne Thomas4,
  9. Valerian Kiggundu5,
  10. Naomi Bock1,
  11. Paran Pordell3,
  12. Caroline Cooney2,
  13. Irum Zaidi2,
  14. Carlos Toledo1
  1. 1 Division of Global HIV and TB, HIV Prevention Branch, Voluntary Medical Male Circumcision Team, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2 President’s Emergency Plan for AIDS Relief, Office of the U.S. Global AIDS Coordinator and Health Diplomacy, Washington, District of Columbia, USA
  3. 3 Division of Global HIV and TB, Monitoring, Evaluation, and Data Analytics Branch, Clinical Monitoring and Evaluation Team, US Centers for Disease Control and Prevention, Atlanta, Georgia
  4. 4 US Department of Defense HIV/AIDS Prevention Program (DHAPP), Naval Health Research Center, San Diego, California, USA
  5. 5 United States Agency for International Development, Global Health Bureau, Office of HIV/AIDS, Prevention, Care and Treatment Division, Washington, District of Columbia, USA
  1. Correspondence to Dr Stephanie M Davis; vic6{at}cdc.gov

Abstract

Objective This article provides an overview and interpretation of the performance of the US President’s Emergency Plan for AIDS Relief’s (PEPFAR’s) male circumcision programme which has supported the majority of voluntary medical male circumcisions (VMMCs) performed for HIV prevention, from its 2007 inception to 2017, and client characteristics in 2017.

Design Longitudinal collection of routine programme data and disaggregations.

Setting 14 countries in sub-Saharan Africa with low baseline male circumcision coverage, high HIV prevalence and PEPFAR-supported VMMC programmes.

Participants Clients of PEPFAR-supported VMMC programmes directed at males aged 10 years and above.

Main outcome measures Numbers of circumcisions performed and disaggregations by age band, result of HIV test offer, procedure technique and follow-up visit attendance.

Results PEPFAR supported a total of 15 269 720 circumcisions in 14 countries in Southern and Eastern Africa. In 2017, 45% of clients were under 15 years of age, 8% had unknown HIV status, 1% of those tested were HIV+ and 84% returned for a follow-up visit within 14 days of circumcision.

Conclusions Over 15 million VMMCs have been supported by PEPFAR since 2007. VMMC continues to attract primarily young clients. The non-trivial proportion of clients not testing for HIV is expected, and may be reassuring that testing is not being presented as mandatory for access to circumcision, or in some cases reflect test kit stockouts or recent testing elsewhere. While VMMC is extremely safe, achieving the highest possible follow-up rates for early diagnosis and intervention on complications is crucial, and programmes continue to work to raise follow-up rates. The VMMC programme has achieved rapid scale-up but continues to face challenges, and new approaches may be needed to achieve the new Joint United Nations Programme on HIV/AIDS goal of 27 million additional circumcisions through 2020.

  • public health
  • preventive medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors SMD drafted and finalised the manuscript. JZH, MH, JMG, RR, JD, AT, VK, CC and NB revised the manuscript.BB and PP revised the data and manuscript. CT conceived of the paper, obtained the data and revised the manuscript. IZ oversaw all data collection.

  • Funding It was supported in part by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement As described in this article, the dataset underlying the tables and results is publicly available at https://data.pepfar.net/quarterlyData/.

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