An Integrated Service Delivery Model for Scaling Up Voluntary Medical Male Circumcision in Lesotho

The pilot was designed and implemented by the Ministry of Health (MOH) and the Maternal and Child Health Integrated Program (MCHIP) led by Jhpiego and funded by the U.S. Agency for International Development (USAID). The goal of the pilot was to investigate the feasibility, demand for VMMC, and uptake of HIV testing using an integrated model that leverages existing public health system structures. Demand creation activities included displaying posters announcing the availability of VMMC services twice a week, and most clients learned about the service through word-of-mouth communication. Training courses were held for nurses, doctors, and counselors at these facilities using the World Health Organization/UNAIDS/Jhpiego manual. The pilot assessed scale-up feasibility by measuring demand, numbers of male circumcisions performed, and rate of HIV testing among VMMC clients. Between March and September 2012, 6,960 clients (over 80% between 15 and 24 years) were voluntarily circumcised. The rate of moderate adverse events was reported at 1.8%, and 96% of clients agreed to undergo HIV testing. HIV positive rate was 3% of total clients, representing 3.8% of total tested clients. The number of males circumcised as part of the minimum package of VMMC for HIV prevention services was 6,960, with 241 clients aged 10-14 years, 3,248 clients aged 15-19 years, 2,339 clients aged 20-24 years, 1,123 clients aged 25-49 years, and 9 clients aged 50+ years. The integrated model provided an important access point for HIV testing and counseling for this high-risk group (males 15-24 years old). Challenges include addressing the shortage of doctors in Lesotho and ensuring that current health system structures continue to accommodate the high demand. The pilot demonstrated that VMMC provided through existing health system structures is a successful method of ensuring high service uptake in Lesotho, representing an important increase compared to the total 400 VMMCs that were conducted in these sites during 10 months prior.