title: Voluntary medical male circumcision: matching demand and supply with quality and efficiency in a high-volume campaign in Iringa Region, Tanzania.
abstract: The government of Tanzania has adopted voluntary medical male circumcision (VMMC) as an important component of its national HIV prevention strategy and is scaling up VMMC in eight regions nationwide, with the goal of reaching 2.8 million uncircumcised men by 2015. In a 2010 campaign lasting six weeks, five health facilities in Tanzania's Iringa Region performed 10,352 VMMCs, which exceeded the campaign's target by 72%, with an adverse event (AE) rate of 1%. HIV testing was almost universal during the campaign. Through the adoption of approaches designed to improve clinical efficiency-including the use of the forceps-guided surgical method, the use of multiple beds in an assembly line by surgical teams, and task shifting and task sharing-the campaign matched the supply of VMMC services with demand. Community mobilization and bringing client preparation tasks (such as counseling, testing, and client scheduling) out of the facility and into the community helped to generate demand. This case study suggests that a campaign approach can be used to provide high-volume quality VMMC services without compromising client safety, and provides a model for matching supply and demand for VMMC services in other settings.
authors.affiliation: Jhpiego/Tanzania, Dar es Salaam, Tanzania. hmahler@jhpiego.net
authors.forename: Hally R
authors.initials: HR
authors.lastname: Mahler
authors.forename: Baldwin
authors.initials: B
authors.lastname: Kileo
authors.forename: Kelly
authors.initials: K
authors.lastname: Curran
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.forename: Tigistu
authors.initials: T
authors.lastname: Adamu
authors.forename: Augustino
authors.initials: A
authors.lastname: Hellar
authors.forename: Sifuni
authors.initials: S
authors.lastname: Koshuma
authors.forename: Simeon
authors.initials: S
authors.lastname: Nyabenda
authors.forename: Michael
authors.initials: M
authors.lastname: Machaku
authors.forename: Mainza
authors.initials: M
authors.lastname: Lukobo-Durrell
authors.forename: Delivette
authors.initials: D
authors.lastname: Castor
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Njeuhmeli
authors.forename: Bennett
authors.initials: B
authors.lastname: Fimbo
mesh_terms: D002944:Circumcision, Male / Q000379:methods / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000458:organization & administration; D037001:Directive Counseling; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006268:Health Facilities / Q000706:statistics & numerical data / Q000600:supply & distribution; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000458:organization & administration; D010348:Patient Care Team / Q000706:statistics & numerical data; D013636:Tanzania / Q000453:epidemiology; D000078329:Workforce