Joint PEPFAR/WHO Meeting on Accelerating the Scale-up of Voluntary Medical Male Circumcision (VMMC) for HIV Prevention in East and Southern Africa

From 25–28 September 2012, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and the World Health Organization (WHO) jointly sponsored a regional technical meeting, which focused on accelerating scale-up of Voluntary Medical Male Circumcision (VMMC) in East and Southern Africa. This meeting convened Ministry of Health, Ministry of Defense, and implementing partner representatives from the following 14 priority countries: Botswana, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe.

The meeting organizers (WHO and PEPFAR) are in the process of finalizing a meeting report that documents what transpired over the four days. This report will be posted when available. 

Presentations given during this meeting provided information and guidance on a number of issues that are critical to successful scale-up and implementation of VMMC programs.

DAY ONE

Session One 

• WHO Opening Remarks by Emil Asamoah-Odei, WHO 

Session Two

• Joint Strategic Action Framework to Accelerate the Scale-Up of VMMC for HIV Prevention in ESA 2012–2016 by Frank Lule, WHO 

Session Three

• Overview of VMMC Progress in Countries by Buhle Ncube, WHO 

• Report from WHO/UNAIDS Meeting for M&E for the Scale-Up of Male Circumcision in 14 Countries in ESA by Sibongile Dludlu, UNAIDS (presented by Buhle Ncube, WHO) 

Session Four

       Implementation Strategies

• Tanzania by Jackson Lija, MOHSW 

• Malawi by Amon Nkhata, MOH 

       Innovations in VMMC Service Delivery

• Kenya by Charles Okal, MPHS 

• South Africa by Dino Rech, CHAPS 

       Challenges in Providing VMMC Services

• Namibia by Epafras Anyolo, MOHSS 

• Botswana by Conrad Ntsuape, MOH 

Session Five: Considerations on Establishing Sustainable VMMC Services

• Infant Male Circumcision Services in Swaziland by Vusi Maziya, MOH 

• Linking VMMC for HIV Prevention and Other Adolescent Health Interventions by Rachel Baggaley, WHO 

• Comprehensive Package of VMMC Services in Ethiopia: Introducing a Tool for Promoting Integration of HIV Prevention into Routine Care in Primary Health Care Settings: A Collaborative Initiative between WHO and CDC by Innocent Ntaganira, WHO 

Session Six: Donors’ Support to Voluntary Medical Male Circumcision Rollout

• VMMC: PEPFAR’s Financial Support and Technical Considerations by Jason Reed, OGAC 

• VMMC in Military Populations: September 2012 Update by Anne Thomas, US DOD 

• Global Fund Support to VMMC by Ade Fakoya, Global Fund 

• Bill & Melinda Gates Foundation (BMGF) Support to VMMC by Paulin Basinga and Renee Ridzon, BMGF 

• World Bank Support for Achieving VMMC Targets by Nicole Fraser, World Bank 

DAY TWO

Session One: VMMC Communication: Key Elements of a Comprehensive Package

• Fundamentals of Comprehensive VMMC Communication by Kim Seifert-Ahanda, USAID 

Session Two: Panel Discussion: Communication Issues, Demand Creation

• VMMC Demand Creation: Elements, Issues, and Ideas by Dan Rutz, CDC 

• Key Influences on Demand: Male Circumcision in Zambia, Working with Traditional Leaders by Daniel Makawa, MOH 

• Getting to Know Key Audiences: Field Research that Informs Demand Creation Strategy by Hally Mahler, Jhpiego Tanzania 

• School of Hard Knocks: How to Talk about the Elephant in the Room? What Works, What Doesn’t, New Approaches in Reaching Adult Men by Beth Deutsch, USAID Malawi 

• Running a Demand Creation Campaign: Putting the Essential Pieces Together and Keeping It Going by Karin Hatzold, PSI Global 

• Evaluation: Real-Time Event-Monitoring for Course Correction and Post-Event Analysis—Making It Even Better Next Time by Mandla Ndlovu, JHHESA South Africa 

Session Three: Panel Discussion: Communication Issues—Working with Journalists and Media, Dealing with Negative Press, Generating Positive Press

• Introduction/Overview: Proactive Strategy, Negative Coverage Analysis by Dan Rutz, CDC 

• Partners for Positive VMMC Coverage: How Advocacy Partnerships Can Influence VMMC News Coverage by Emily Bass, AVAC 

• News Media Surveillance: Media Survey Description and (Limited) Data Discussion by Kim Seifert-Ahanda, USAID 

• Global VMMC Media Coordination: Appraising VMMC Coverage Trends, Globally, for Better Proactive Response at the Country Level by Zenawit Melesse, UNAIDS 

• Information Sharing: Male Circumcision Clearinghouse by Julia Samuelson, WHO 

• Managing Controversy: Uganda Government Handling of Negative and Inaccurate Press by Barbara Nanteza, MOH

Session Four: Use of Devices for Adolescent and Adult Male Circumcision

• Context of Device Introduction by Jason Reed, OGAC 

• WHO Information Products/Guidance by Julia Samuelson, WHO 

• Research Status of VMMC Devices by Tim Farley, WHO Consultant 

• Prequalification of Devices for Male Circumcision by Julia Samuelson, WHO 

• Unit Cost Drivers and Impact of Device Costs by Emmanuel Njeuhmeli, USAID

Session Five: Breakout Sessions on Key Programmatic Issues

      Human Resources Including Task Shifting and Task Sharing

• Strategies for Meeting the HR Needs of the VMMC Scale-Up by Kelly Curran, Jhpiego 

• Efficiencies That Assist in Addressing HR Constraints by Dino Rech, CHAPS 

       Logistics and Commodities

• Experiences with Commodities: Tanzania 

• Quantification in VMMC: The Need for Planning by Juan Jaramillo, SCMS 

• Building a Comprehensive Health Care Waste Management System: Swaziland by Maqhawe Magongo, MOH 

• Male Circumcision Logistics Update: Zimbabwe 

• Logistics and Commodities Questions 

       Monitoring and Evaluation

• PEPFAR Male Circumcision M&E Indicators by Brian Agbiriogu, USAID 

• Male Circumcision Monthly Report Status September 2009–August 2012 

• Developing a Countrywide M&E System for VMMC by Bbaale Denis, IDI Uganda 

• Swaziland’s VMMC Adverse Event Reporting System by Jonathan Grund, CDC 

• Reporting and Recording for VMMC in Tanzania 

• Male Circumcision Services Monthly Site Summary Form, MOHSW Tanzania 

• Development of Tools for Monitoring & Reporting VMMC Program Indicators by Anne Thomas, US DOD  

       Introduction of Non-Surgical Devices

• Lessons from Student Nurses’ FP Program in Zimbabwe by Cynthia Chasokela, MOHCW 

• Donor Funding for Device Studies 

• Introduction of Non-Surgical VMMC Devices by Tim Farley, WHO Consultant

• PrePex Acceptability Protocols: Mozambique and Botswana, Review of Key Issues by Mary Glenshaw, CDC Botswana, and Beverly Cummings, CDC Mozambique 

DAY THREE

Session One

• Human Resources Issues by Kelly Curran, Jhpiego 

Session Two: Coordination and Accountability for VMMC

• Tanzania Experience by Awene Gavyole, WHO 

• Male Circumcision in Zambia: National Operational Plan for Scale-Up by Daniel Makawa, WHO 

Session Three: Country Breakout Sessions

• Coordination and Accountability and Annual Operating Plans, Buhle Ncube, WHO, and Jason Reed, OGAC 

DAY FOUR

Session One: Leadership and Advocacy for VMMC Scale-Up

• Zimbabwe by Gertrude Ncube, MOHCW 

• Lesotho by John Nkonyana, MOH 

Session Two: Update on PEPFAR Headquarter Activities

• Overview of PEPFAR Draft Operational Guide for VMMC Services: A Service Guide for Site Operations by Emmanuel Njeuhmeli, USAID 

• A Resource for Demand Creation and Promotion of VMMC for HIV Prevention by Dan Rutz, CDC 

• Logistics and Supply Chain Readiness by Dianna Edgil, USAID 

• The Value of Modeling and Costing Studies for VMMC by Emmanuel Njeuhmeli, USAID 

• Quality Assurance Assessments at VMMC Sites by Michael Qualls, CDC 

• Development of Tools for Monitoring & Reporting VMMC Program Indicators by Anne Thomas, US DOD 

Session Three: Panel Discussion: Voluntarism, Use of Reimbursements or Incentives

• Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for Decision-Makers on Human Rights, Ethical and Legal Considerations by Celeste Sandoval, UNAIDS 

• Conditional In-Kind Compensation to Increase Uptake of VMMC: A Randomized Controlled Trial in Nyando District, Kenya, by Kawango Agot, IRDO 

Session Four: Next Steps

• Joint PEPFAR-WHO Meeting on Accelerating the Scale-Up of VMMC for HIV Prevention in ESA: Next Steps by Emil Asamoah-Odei, WHO