Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois, United States of America.
PLoS One. 2011 Apr 4;6(4):e18299. doi: 10.1371/journal.pone.0018299.
In 2007, the World Health Organization endorsed male circumcision as an effective HIV prevention strategy. In 2008, the Government of Kenya (GoK) launched the national voluntary medical male circumcision (VMMC) program in Nyanza Province, the geographic home to the Luo, the largest non-circumcising ethnic group in Kenya. Currently, several other African countries are in the early stages of implementing this intervention.
This paper uses data from a health facility needs assessment (n = 81 facilities) and a study to evaluate the implementation of VMMC services in 16 GoK facilities (n = 2,675 VMMC clients) to describe Kenya's experience in implementing the national program. The needs assessment revealed that no health facility was prepared to offer the minimum package of services as outlined by the national guidelines, and partner organizations were called upon to fill this gap. The findings concerning human resource shortages facilitated the GoK's decision to endorse trained nurses to provide VMMCs, enabling more facilities to offer the service. Findings from the evaluation study resulted in replacing voluntary counseling and testing (VCT) with provider-initiated testing and counseling (PITC) and subsequently doubling the proportion of VMMC clients tested for HIV.
This paper outlines how certain challenges, like human resource shortages and low HIV test rates, were addressed through national policy changes, while other challenges, like large fluctuations in demand, were addressed locally. Currently, the program requires significant support from partner organizations, but a strategic plan is under development to continue to build capacity in GoK staff and facilities. Coordination between all parties was essential and was facilitated through the formation of national, provincial, and district VMMC task forces. The lessons learned from Kenya's VMMC implementation experience are likely generalizable to other African countries.
2007 年，世界卫生组织认可男性割礼是一种有效的艾滋病预防策略。2008 年，肯尼亚政府（GoK）在尼亚萨省启动了全国自愿男性割礼（VMMC）项目，尼亚萨省是肯尼亚最大的未割礼族群卢奥人的故乡。目前，其他几个非洲国家正处于实施这一干预措施的早期阶段。
本文使用卫生机构需求评估（n=81 个机构）和一项评估 16 个 GoK 机构实施 VMMC 服务的研究（n=2675 名 VMMC 客户）的数据，描述肯尼亚实施国家方案的经验。需求评估显示，没有一家卫生机构准备提供国家指南所概述的最低一揽子服务，因此需要合作伙伴组织来填补这一空白。关于人力资源短缺的调查结果促成了 GoK 决定授权接受过培训的护士提供 VMMC，使更多的机构能够提供这项服务。评估研究的结果导致用医护人员主动提供艾滋病毒检测和咨询（PITC）取代了自愿咨询和检测（VCT），随后将接受 HIV 检测的 VMMC 客户比例提高了一倍。
本文概述了如何通过国家政策的改变来解决某些挑战，如人力资源短缺和艾滋病毒检测率低，而其他挑战，如需求的大幅波动，则是在地方一级解决的。目前，该方案需要合作伙伴组织的大力支持，但正在制定一项战略计划，以继续加强 GoK 工作人员和机构的能力。所有各方之间的协调至关重要，这是通过成立国家、省和地区 VMMC 工作队来实现的。肯尼亚 VMMC 实施经验中吸取的教训可能适用于其他非洲国家。
