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A monitoring and evaluation study to assess the implementation of male circumcision for HIV prevention in Kenya: an interim analysis
A. Herman-Roloff1, R. Bailey2, K. Agot3, J. Ndinya-Achola4
1University of Illinois Chicago / Nyanza Reproductive Health Society, Epidemiology, Kisumu, Kenya, 2University of Illinois at Chicago, Epidemiology, Chicago, United States, 3Impact Research and Development Organization, Kisumu, Kenya, 4University of Nairobi, Department of Medical Microbiology, Nairobi, Kenya
Background: The Male Circumcision Consortium is supporting the Government of Kenya (GoK) to scale-up male circumcision (MC) services in Nyanza Province, Kenya. Monitoring and evaluation (M&E) is essential to assess risk compensation, safety and acceptability. This study focuses on MC safety and acceptability.
Methods: The M&E system, comprised of a passive, clinic-based system and an active, home-based system, was implemented in 16 GoK facilities in November, 2008. These systems monitor MC clients from pre-procedure through 40-days post-MC. Males, aged ≥ 18 years, who are circumcised at a study facility are eligible to enroll.
Results: Of the 1,201 MC clients invited to enroll, 1,178 (98.1%) accepted. 22.8% of clients completed HIV testing prior to MC, while 56.8% self-reported their HIV status. Clients reported the following reasons influencing their MC decision: HIV protection (46.5%), hygiene (25.2%) and STI protection (15.8%). 62.0% of clients returned to the facility for at least one follow-up visit, a mean of 8.6 days after MC. By this visit, 93.9% had returned to normal activities, and 99.1% reported satisfaction with their circumcision. The adverse event (AE) rate during the procedure was negligible (0.2%) and the post-procedure AE rate was small (3.2%); the most common AEs were swelling, infection, and delayed healing. To date, 245 clients have been interviewed for the active, home-based M&E system (30-40 days post-MC); 100% reported satisfaction with their circumcision; 10% were not healed, 36.6% had initiated sex, and the AE rate was 6.9%. When compared with the active system, the clinic system had low sensitivity in ascertaining AEs (sensitivity = 17%).
Conclusions: This study confirmed that MC can be scaled-up safely and with high acceptability. Acceptance of VCT was low, hence innovative approaches, such as opt-out testing, should be explored. MC counseling guidelines need review since a significant proportion of clients engaged in sex before 30-40 days post-MC.
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