Research Article: A Model for the Roll-Out of Comprehensive Adult Male Circumcision Services in African Low-Income Settings of High HIV Incidence: The ANRS 12126 Bophelo Pele Project

Date Published: July 20, 2010

Publisher: Public Library of Science

Author(s): Pascale Lissouba, Dirk Taljaard, Dino Rech, Sean Doyle, Daniel Shabangu, Cynthia Nhlapo, Josephine Otchere-Darko, Thabo Mashigo, Caitlin Matson, David Lewis, Scott Billy, Bertran Auvert, Agnes Binagwaho

Abstract: Bertrand Auvert and colleagues describe the large-scale roll-out of adult male circumcision through a program in South Africa.

Partial Text: Because three randomized controlled trials conducted in sub-Saharan Africa have demonstrated a significant protective effect of about 60% of adult male circumcision (AMC) on male HIV acquisition [1]–[3], AMC has been recognized as an additional, important strategy for the prevention of heterosexually acquired HIV infection in men [4],[5]. Following a World Health Organization (WHO)/Joint United Nations Programme on AIDS (UNAIDS)-led international consultation, AMC scale-up was recommended to reduce the spread of HIV in countries where HIV is hyperendemic and AMC prevalence is low [5].

Findings from the activities conducted before the start of the project were as follows: The community consultation showed high levels of acceptability and support for the project and the cross-sectional survey indicated that willingness to undergo AMC was high and predicted a substantial AMC uptake among uncircumcised adult men, who were for the most part unaware of the AMC trial that had been conducted previously in the community (Table 1). The focus group discussion study showed that the quality of AMC messaging was satisfactory and that information recall remained high in the 4-mo time frame (see Table S1). The nested study suggested that the vast majority of respondents displayed high counseling recall and reported high adherence to behavioral directives after 2 mo (Table 2).

As indicated by the substantial levels of community support, AMC uptake, and participants’ satisfaction, the roll-out of free medicalized AMC as an intervention against HIV in the Orange Farm community has been a success. The study has shown that the scale-up of comprehensive, high-quality AMC services can be achieved according to international recommendations and operational guidelines in a low-income African setting with low AMC rates and high HIV prevalence.