title: Programme science research on medical male circumcision scale-up in sub-Saharan Africa.
abstract: Three randomised trials demonstrate that voluntary medical male circumcision (MMC) reduces male HIV acquisition by 50-60%, and post-trial surveillance has shown that the effects are long lasting. Scale-up of services has been initiated in 14 high-priority sub-Saharan African countries with high rates of HIV and low prevalence of MMC. However, circumcision coverage in the region remains low. Challenges to MMC rollout include suboptimal demand among higher-risk men, the need to expand access and reduce costs of MMC through personnel task shifting and task sharing, assuring and maintaining a high quality of service provision, and the testing and introduction of non-surgical devices. In addition, early infant male circumcision has not been adequately evaluated in Africa. Here, we describe challenges to implementation and discuss the ongoing and future role of implementation and programme science in addressing such challenges.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. rgray@jhsph.edu
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D002944:Circumcision, Male / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000592:standards*; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D016730:Program Development; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012106:Research
keywords: AFRICA; CIRCUMCISION; HIV