RT Journal Article
SR Electronic
T1 Programme science research on medical male circumcision scale-up in sub-Saharan Africa
JF Sexually Transmitted Infections
JO Sex Transm Infect
FD BMJ Publishing Group Ltd
SP 345
OP 349
DO 10.1136/sextrans-2012-050595
VO 89
IS 5
A1 Ronald H Gray
A1 Maria J Wawer
A1 Godfrey Kigozi
YR 2013
UL http://sti.bmj.com/content/89/5/345.abstract
AB 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.