More than 10 years of further evidence that voluntary medical male circumcision (VMMC) for HIV prevention is having a substantial effect in real-world settings guided the development of new World Health Organization (WHO) guidelines, according to a news release. The updated VMMC guidelines present the latest evidence on the impact and cost-effectiveness of continuing VMMC services as part of combination prevention for men and adolescent boys ages 15 years and older, the safety of the use of prequalified devices to perform male circumcision, and interventions to enhance uptake of VMMC services among men. They also examine factors to consider when deciding whether to offer VMMC to younger adolescent boys (ages 10 to 14 years), including diversity in physical and cognitive development and the capacity to consent. The guidelines outline a framework to guide health systems as they transition from dedicated VMMC services to more integrated, adolescent-focused services designed to sustain high VMMC coverage and address other health care needs (AllAfrica, 21 August 2020).
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As South Africa went into a coronavirus lockdown in March, non-emergency procedures such as voluntary medical male circumcision (VMMC) were stopped. Many of the organisations providing VMMC services began supporting COVID-19 screening and testing, and their teams quickly saw a need to apply lessons from their HIV prevention experience. In a comment published by Bhekisisa, the head of one of those organisations writes that “time-tested lessons … about building community trust and battling misinformation are just as important in today’s COVID-19 response as they have been to us in the HIV field for the past two decades” (Bhekisisa, 22 June 2020).
Measures to prevent COVID-19 have slowed down Zimbabwe’s voluntary medical male circumcision (VMMC) programme, the Chronicle reports. To avert new HIV infections, the country’s Ministry of Health and Child Care (MOHCC) aims to circumcise about 400,000 men in 2020. As of April 2020, however, only 37,060 men had been circumcised. The director of the HIV, AIDS and TB Unit in the MOHCC is quoted as saying that the VMMC programme’s goal for the year is achievable despite the challenges posed by the COVID-19 pandemic (Chronicle [Zimbabwe,] 15 June 2020).
The U.S. Centers for Disease Control and Prevention (CDC) and Project ECHO are hosting a weekly webinar series about infection prevention and control (IPC) in the context of COVID-19 every Thursday through 6 August 2020 from 9:00–10:30 a.m. EDT and from 12:00–1:30 p.m. CST. Speakers from CDC, the World Health Organization, and IPC professional societies will focus on practical advice and implementation considerations for IPC in health care settings. These 90-minute sessions will provide equal time for presentations and discussion. IPC professionals, Ministry of Health staff, partner organizations, and any interested healthcare workers are encouraged to participate. Please contact IPCECHO@salud.unm.edu for registration information.
Practical IPC Considerations in the Fight Against COVID-19: Webinar Topics
• Healthcare facility readiness and monitoring
• Healthcare worker risk assessment, monitoring, and other staff considerations
• Assessing SARS-CoV-2 infection among healthcare workers and inpatients
• Cleaning and disinfection in the context of COVID-19
• WASH in healthcare settings in the context of COVID-19
• Limiting the introduction of COVID-19 in healthcare settings
• Rational use of personal protective equipment and emergency strategies
• Advice on the use of medical and non-medical masks
• IPC in nursing homes and long-term care settings
• Considerations for SARI treatment centers
• Post-mortem considerations in context of COVID-19
HIV prevention services are among those most disrupted by restrictions designed to reduce the spread of COVID-19 in five countries in sub-Saharan Africa, reports Open Democracy and the Mail & Guardian. In 24 interviews conducted by Open Democracy, an independent global media organisation, health workers and sex workers in Kenya, Mozambique, Nigeria, South Africa, and Uganda reported devising creative ways to ensure that registered HIV patients continue receiving drugs for treatment. But HIV testing, pre-exposure prophylaxis, drop-in centres for vulnerable groups, and voluntary medical male circumcision — services vital to detecting and preventing new HIV infections — have been scaled back or closed. Similar HIV service reductions were reported in March to an International Planned Parenthood Federation survey of its network of clinics in 10 other Africa countries (Mail & Guardian, 4 June 2020).
The Council of Traditional Leaders of South Africa has cancelled this year’s winter initiation season over fears about the potential for COVID-19 to spread quickly among initiates, HeraldLIVE reports. The institutions’ national executive committee unanimously agreed on the cancellation after consulting with the leaders of the cultural committees that practice the customary rite of passage in South Africa’s nine provinces. A spokesperson for Eastern Cape Co-operative Governance and Traditional Affairs is quoted as saying that anyone operating an initiation school during the winter season will be prosecuted under the regulations governing COVID-19 as well as the Customary Male Initiation Practice Act. No decision has yet been made about whether initiation ceremonies will be permitted later in the year (HeraldLIVE, 18 May 2020).
Voluntary medical male circumcision (VMMC) for HIV prevention was highlighted in 21 abstracts during the annual Conference on Retroviruses and Opportunistic Infections (CROI), which was held virtually from 8 to 11 March 2020.
VMMC was highlighted in an opening session lecture about translating HIV science into public health impact, a plenary talk about lessons from recent trials of combination HIV prevention, and an oral abstract session about rapid declines in new HIV infections in men and women in Rakai, Uganda. A total of 17 posters were devoted to VMMC, including posters on the long-term effectiveness of VMMC for HIV prevention, a cluster randomised trial to increase VMMC uptake among men older than 18, and a potential biological mechanism for VMMC’s protective effect against HIV.
Click here for links to the abstracts and posters. Webcasts of conference sessions will be available to non-registrants about a week after the last day of the conference.
In less than 10 minutes, you can complete a survey collecting data to guide protection of the health and safety of health workers during the COVID-19 pandemic. Developed by an international group of experts convened by the World Health Organization and the International Labour Organization, this survey seeks respondents who play a role in the protection of health workers. The target group of respondents is broad, from professionals providing services for occupational safety and health, infection prevention and control, and psychosocial support to frontline health workers, managers, and decision makers in health and related sectors and academia. The survey is now available in English, Chinese, French, German, Portuguese, Russian, Spanish, and Swahili. The organizers encourage sharing of the survey links by email and through social media to encourage input on urgent measures to improve health and safety.
Disruptions in HIV services resulting from the COVID-19 pandemic could lead to as many as 673,000 extra AIDS-related deaths in sub-Saharan Africa by the end of next year, POZ reports. Modeling experts assembled by the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS) analysed the effects of potential reductions in access to HIV treatment, viral load testing, condom distribution, HIV testing, and voluntary medical male circumcision over three and six months. The half-year model estimates that 471,000 to 673,000 people could die in addition to the hundreds of thousands in the region whose lives are claimed each year by HIV-related causes (about 470,000 in 2018). UNAIDS and its partners in the Global HIV Prevention Coalition have published a series of documents to help countries safeguard the health of vulnerable people during the COVID-19 pandemic (POZ, 12 May 2020).
One of the South African communities hardest hit by HIV, the town of Eshowe in KwaZulu-Natal, has begun to turn the tide against the epidemic. A pilot project begun by the international nongovernmental organization Médicins Sans Frontières in 2011 included a massive distribution of free condoms, promotion of adult medical male circumcision, a schools scheme, outreach to community leaders and traditional health practitioners, mobile HIV testing vans, and the deployment of huge numbers of community health workers. National health authorities have introduced many of the initiatives piloted in Eshowe to reduce new HIV infections in other areas of South Africa. An article in The Guardian discusses how lessons from this experience are being applied to respond to another global pandemic, COVID-19 (The Guardian, 7 April 2020).
On 7 April 2020 — World Health Day — WHO celebrates nurses and midwives, recognizes the critical role they play in keeping the world healthy, and calls for urgent investments in nursing education, jobs, and leadership. WHO also marked the day by launching the first-ever State of the World’s Nursing report.
Progress against HIV made through expanded testing and treatment, pre-exposure prophylaxis, voluntary medical male circumcision, and targeted interventions for young women and girls is imperiled by the COVID-19 pandemic, warns a Washington Post profile of Dr. Deborah Birx, the U.S. global AIDS coordinator, who is also coordinating the White House coronavirus task force. The article cites challenges maintaining people living with HIV on antiretroviral treatment and the possibility of future reductions in funding for HIV programmes. It suggests that “having the head of the US President’s Emergency Plan for AIDS Relief (PEPFAR), who is intimately aware of the ins and outs of every country’s treatment programme, in charge of the coronavirus outbreak might just make the difference — for not just one epidemic but two” (The Washington Post, 25 March 2020).
The introduction and scale-up of voluntary medical male circumcision (VMMC) is one of several interventions that led to an impressive decline in new HIV infections in Kenya, writes one of the principal investigators for the 2018 Kenya Population-based HIV Impact Assessment (KENPHIA) in a reflection on the HIV response in his country. Dr. Peter Cherutich of Kenya’s Ministry of Health describes how, beginning in 2008, Kenya “quickly mobilised technical teams to expand one of the largest surgical interventions of our time,” reaching close to 1 million men with VMMC. KENPHIA 2018 found that the rate of new infections was 0.14%, down from 0.5% in 2012 (The Star, 20 March 2020).
Reductions in new HIV infections among Ugandan women as well as men are due in part to scale-up of voluntary medical male circumcision (VMMC) and antiretroviral therapy (ART), Healio reports. Data from the Rakai Community Cohort Study presented during the 2020 Conference on Retroviruses and Opportunistic Infections (CROI) revealed a recent dramatic decline in HIV incidence among women, whose rates had not been falling as steeply as men’s. Overall, the rate of new HIV infections among women in Rakai has dropped 60% since the introduction of ART and VMMC (Healio, 12 March 2020).
The 20th International Conference on AIDS and STIs in Africa (ICASA), to be held in Kigali in December, will provide an opportunity for Rwandans to share what they have learned about preventing HIV infections and increasing the life expectancy of people living with HIV, The New Times reports. The successful approaches described in the article include providing antiretroviral treatment to all HIV-positive individuals regardless of viral load, decentralizing HIV testing and treatment services to 510 public health facilities, dispatching mobile condom kiosks to “hot spots” of risky sexual activity, and providing voluntary medical male circumcision (VMMC) services. The proportion of men who were circumcised doubled from 13 percent in 2010 to 30 percent to 2015 (The New Times, 18 November 2019).