Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1.
Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of...
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Public Library of Science (PLoS)
2021
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oai:doaj.org-article:9e428ef660c14eae9546730440463eab2021-12-02T20:07:09ZMaking voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1.1932-620310.1371/journal.pone.0252725https://doaj.org/article/9e428ef660c14eae9546730440463eab2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252725https://doaj.org/toc/1932-6203Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of service provision domestically owned and implemented. Using pre-defined metrics, we created and evaluated three models of circumcision service delivery (static, mobile and mixed) to identify which had potential for sustaining high circumcision coverage among 10-14-year-olds group, a historically high-demand and accessible age group, at the lowest possible cost. We implemented each model in two distinct geographic areas, one in Siaya and the other in Migori county, and assessed multiple aspects of each model's sustainability. These included numerical achievements against targets designed to reach 80% coverage over two years; quantitative expenditure outcomes including unit expenditure plus its primary drivers; and qualitative community perception of program quality and sustainability based on Likert scale. Outcome values at baseline were compared with those for year one of model implementation using bivariate linear regression, unpaired t-tests and Wilcoxon rank tests as appropriate. Across models, numerical target achievement ranged from 45-140%, with the mixed models performing best in both counties. Unit expenditures varied from approximately $57 in both countries at baseline to $44-$124 in year 1, with the lowest values in the mixed and static models. Mean key informant perception scores generally rose significantly from baseline to year 1, with a notable drop in the area of community engagement. Consistently low scores were in the aspects of domestic financing for service provision. Sustainability-focused circumcision service delivery models can successfully achieve target volumes at lower unit expenditures than existing models, but strategies for domestic financing remain a crucial challenge to address for long-term maintenance of the program.Stephanie M DavisNandi OwuorElijah Odoyo-JuneJonesmus WambuaEunice OmangaMainza LukoboCatharine LaubeZebedee MwandiChutima SuraratdechaUrbanus M KiokoWesley RotichJacquin KatakaCaroline Ng'enoDiwakar MohanCarlos ToledoAppolonia AokoJohn AnyangoDaniel OneyaKennedy OrenjuroElizabeth MgambKennedy SerremAmbrose JumaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252725 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Medicine R Science Q |
| spellingShingle |
Medicine R Science Q Stephanie M Davis Nandi Owuor Elijah Odoyo-June Jonesmus Wambua Eunice Omanga Mainza Lukobo Catharine Laube Zebedee Mwandi Chutima Suraratdecha Urbanus M Kioko Wesley Rotich Jacquin Kataka Caroline Ng'eno Diwakar Mohan Carlos Toledo Appolonia Aoko John Anyango Daniel Oneya Kennedy Orenjuro Elizabeth Mgamb Kennedy Serrem Ambrose Juma Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. |
| description |
Voluntary medical male circumcision is a crucial HIV prevention program for men in sub-Saharan Africa. Kenya is one of the first countries to achieve high population coverage and seek to transition the program to a more sustainable structure designed to maintain coverage while making all aspects of service provision domestically owned and implemented. Using pre-defined metrics, we created and evaluated three models of circumcision service delivery (static, mobile and mixed) to identify which had potential for sustaining high circumcision coverage among 10-14-year-olds group, a historically high-demand and accessible age group, at the lowest possible cost. We implemented each model in two distinct geographic areas, one in Siaya and the other in Migori county, and assessed multiple aspects of each model's sustainability. These included numerical achievements against targets designed to reach 80% coverage over two years; quantitative expenditure outcomes including unit expenditure plus its primary drivers; and qualitative community perception of program quality and sustainability based on Likert scale. Outcome values at baseline were compared with those for year one of model implementation using bivariate linear regression, unpaired t-tests and Wilcoxon rank tests as appropriate. Across models, numerical target achievement ranged from 45-140%, with the mixed models performing best in both counties. Unit expenditures varied from approximately $57 in both countries at baseline to $44-$124 in year 1, with the lowest values in the mixed and static models. Mean key informant perception scores generally rose significantly from baseline to year 1, with a notable drop in the area of community engagement. Consistently low scores were in the aspects of domestic financing for service provision. Sustainability-focused circumcision service delivery models can successfully achieve target volumes at lower unit expenditures than existing models, but strategies for domestic financing remain a crucial challenge to address for long-term maintenance of the program. |
| format |
article |
| author |
Stephanie M Davis Nandi Owuor Elijah Odoyo-June Jonesmus Wambua Eunice Omanga Mainza Lukobo Catharine Laube Zebedee Mwandi Chutima Suraratdecha Urbanus M Kioko Wesley Rotich Jacquin Kataka Caroline Ng'eno Diwakar Mohan Carlos Toledo Appolonia Aoko John Anyango Daniel Oneya Kennedy Orenjuro Elizabeth Mgamb Kennedy Serrem Ambrose Juma |
| author_facet |
Stephanie M Davis Nandi Owuor Elijah Odoyo-June Jonesmus Wambua Eunice Omanga Mainza Lukobo Catharine Laube Zebedee Mwandi Chutima Suraratdecha Urbanus M Kioko Wesley Rotich Jacquin Kataka Caroline Ng'eno Diwakar Mohan Carlos Toledo Appolonia Aoko John Anyango Daniel Oneya Kennedy Orenjuro Elizabeth Mgamb Kennedy Serrem Ambrose Juma |
| author_sort |
Stephanie M Davis |
| title |
Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. |
| title_short |
Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. |
| title_full |
Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. |
| title_fullStr |
Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. |
| title_full_unstemmed |
Making voluntary medical male circumcision services sustainable: Findings from Kenya's pilot models, baseline and year 1. |
| title_sort |
making voluntary medical male circumcision services sustainable: findings from kenya's pilot models, baseline and year 1. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/9e428ef660c14eae9546730440463eab |
| work_keys_str_mv |
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