Materials and Links

Background:

Male circumcision has the potential to significantly reduce the spread of HIV by protecting HIV-uninfected men against acquisition of HIV infection through sexual intercourse with HIV-infected women. The risk of HIV infection was reduced by approximately 60% in three separate randomized clinical trials. Thus, male circumcision is the only biomedical intervention with demonstrated efficacy to prevent HIV infection to date. The questions now are: how can this intervention be implemented safely, efficiently and effectively at the population level in regions with a significant number of uncircumcised men at risk for infection? What will the actual demand for male circumcision be in these regions?

The implementation of male circumcision could potentially be facilitated by the development of specific surgical circumcision devices. Although several companies are developing devices (several of these are available on the market), the on-the-ground utility of these has not been demonstrated. Consensus regarding the feasibility, acceptability and utility of such surgical devices had not been reached. In addition to devices, supply kits (providing all needed materials and supplies for circumcision surgeries) have the potential facilitate the implementation of male circumcision on a large scale. Different surgical techniques are being used, differing in their complexity (to be conducted by trained surgeon only or also by other health care workers) and supply requirements. Currently, little information is available on current practice in different regions, needs and satisfaction with available kits. More information is urgently needed to guide reasonably an accurate prediction of what is needed, what will work/ be acceptable in different regions. This then raises the next question: what will the actual demand for male circumcision be?

A more accurate prediction of how many men will request circumcision is needed generally in order to adequately scale up supply chain processes to meet the demand. While several studies have modeled the potential impact of male circumcision on the HIV epidemic, and others have addressed its potential cost-effectiveness, the information on the actual demand for male circumcision is scarce.  One method for estimating demand for male circumcision is based on the acceptability studies that have been performed thus far. While these data do have the potential for providing a baseline of potential demand, more direct methods of assessment need to be implemented. More direct data sources would include, for example, real time health care system level data on circumcisions requested and performed at select sites, population level data on number of adult HIV-infected men in need or circumcision in specific regions, an assessment of the potential impact of public health communication campaigns on the demand for this intervention, etc.

Objectives:

1. To achieve a common understanding of the landscape of surgical device development

2. To review and assess the usefulness of technical innovations and optimization of devices to facilitate rapid scale up of adult male circumcision programs

3. To gain a better understanding of how kits and/or modules of supplies can support scale up of male circumcision programs

4. To discuss options for meeting human resource needs and their associated issues

5. Understand how impact and cost modeling can inform the scale up of male circumcision.

6. Gain a better understanding of what is involved in demand forecasting and managing demand

7. Provide a platform for implementers, practitioners, supply experts, communications specialists, policymakers and researchers to develop a common agenda and inform each other on program needs

Status:

The workshop was held on March 13-14, 2008 in Kampala, Uganda.

Project Co-Sponsors:

Project Manager:

Nyasha Bakare, MD, MPH