title: Mass safe male circumcision: early lessons from a Ugandan urban site - a case study.
abstract: BACKGROUND
  It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach.
  
  
  METHODS
  A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented.
  
  
  RESULTS
  A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs.
  
  
  CONCLUSIONS
  Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.
authors: International Hospital Kampala, Uganda.
authors: Moses
authors: M
authors: Galukande
authors: Denis Bbaale
authors: DB
authors: Sekavuga
authors: Kevin
authors: K
authors: Duffy
authors: Nicholas
authors: N
authors: Wooding
authors: Sam
authors: S
authors: Rackara
authors: Florence
authors: F
authors: Nakaggwa
authors: Teddy
authors: T
authors: Nagaddya
authors: Alex Emmanuel
authors: AE
authors: Elobu
authors: Alex
authors: A
authors: Coutinho
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects / Q000706:statistics & numerical data*; D003376:Counseling / Q000379:methods; D005500:Follow-Up Studies; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D055818:Public-Private Sector Partnerships / Q000458:organization & administration*; D014454:Uganda; D019037:Urban Health Services / Q000458:organization & administration; D055815:Young Adult
keywords: Safe male circumcision; public and private partnership; task shifting
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