Galukande Moses, Sekavuga Denis Bbaale, Duffy Kevin, Wooding Nicholas, Rackara Sam, Nakaggwa Florence, Nagaddya Teddy, Elobu Alex Emmanuel, Coutinho Alex
International Hospital Kampala, Uganda.
Pan Afr Med J. 2012;13:88. Epub 2012 Dec 28.
It has been proven in several randomized clinical trials that HIV transmission from female to male is reduced by 60% and more among circumcised males. The national target for Uganda by 2015 is to circumcise 4.2 million adult males, an unprecedented number requiring a pragmatic approach and effective model(s) to deliver this target. The objective of the study was to describe early lessons learnt at a start up of a mass safe male circumcision (SMC) program in an urban Ugandan site, implemented through task shifting and a private public partnership approach.
A case study of an urban SMC site in Uganda's capital, Kampala with a catchment population of approximately 0.8 million adult males aged between 15 and 49 years. Client enrollment was voluntary; mobilization was by word of mouth and through the media. Non Physician clinicians (NPC) carried out the majority of the SMCs. The SMC and voluntary counseling and testing (VCT), adverse events (AE) management and follow up were done as per set national guidelines. The supervision was by a public and private service provider. All clients were consented.
A total of 3000 males were circumcised in 27 days spread over four months. The AE rate was 2.1% all AEs were mild and reversible. No deaths occurred. The work rate was 111 SMCs per day. There was sufficient demand for SMC despite minimal mobilization effort. The bulk of the SMC work was successfully carried out by the NPCs.
Private Public Partnership and task shifting approaches were successful at the start up phase and we anticipate will be feasible for the scale up.
多项随机临床试验已证实，接受包皮环切术的男性从女性感染艾滋病毒的几率降低了60%以上。乌干达2015年的国家目标是为420万成年男性进行包皮环切术，这一史无前例的数字需要采取务实的方法和有效的模式来实现这一目标。本研究的目的是描述在乌干达一个城市地区启动大规模安全男性包皮环切术（SMC）项目初期所吸取的经验教训，该项目通过任务转移和公私合作伙伴关系方法实施。
对乌干达首都坎帕拉一个城市SMC站点进行案例研究，该站点的服务对象为约80万年龄在15至49岁之间的成年男性。客户登记是自愿的；通过口碑和媒体进行动员。非医师临床医生（NPC）进行了大部分的SMC手术。SMC和自愿咨询检测（VCT）、不良事件（AE）管理及随访均按照既定的国家指南进行。由公共和私人服务提供者进行监督。所有客户均已签署知情同意书。
在四个月内的27天里，共有3000名男性接受了包皮环切术。AE发生率为2.1%，所有AE均为轻度且可逆。无死亡病例发生。工作效率为每天111例SMC手术。尽管动员力度很小，但对SMC仍有足够的需求。大部分SMC工作由NPC成功完成。
公私合作伙伴关系和任务转移方法在启动阶段取得了成功，我们预计在扩大规模时也是可行的。
