Jhpiego, Baltimore, MD, USA
U.S. Agency for International Development (USAID), Mbabane, Swaziland.
Glob Health Sci Pract. 2016 Jul 13;4 Suppl 1(Suppl 1):S76-86. doi: 10.9745/GHSP-D-15-00186. Print 2016 Jul.
The government of the Kingdom of Swaziland recognizes that it must urgently scale up HIV prevention interventions, such as voluntary medical male circumcision (VMMC). Swaziland has adopted a 2-phase approach to male circumcision scale-up. The catch-up phase prioritizes VMMC services for adolescents and adults, while the sustainability phase involves the establishment of early infant male circumcision (EIMC). Swaziland does not have a modern-day tradition of circumcision, and the VMMC program has met with client demand challenges. However, since the launch of the EIMC program in 2010, Swaziland now leads the Eastern and Southern Africa region in the scale-up of EIMC. Here we review Swaziland's program and its successes and challenges.
From February to May 2014, we collected data while preparing Swaziland's "Male Circumcision Strategic and Operational Plan for HIV Prevention 2014-2018." We conducted structured stakeholder focus group discussions and in-depth interviews, and we collected EIMC service delivery data from an implementing partner responsible for VMMC and EIMC service delivery. Data were summarized in consolidated narratives.
Between 2010 and 2014, trained providers performed more than 5,000 EIMCs in 11 health care facilities in Swaziland, and they reported no moderate or severe adverse events. According to a broad group of EIMC program stakeholders, an EIMC program needs robust support from facility, regional, and national leadership, both within and outside of HIV prevention coordination bodies, to promote institutionalization and ownership. Providers and health care managers in 3 of Swaziland's 4 regional hospitals suggest that when EIMC is introduced into reproductive, maternal, newborn, and child health platforms, dedicated staff attention can help ensure that EIMC is performed amid competing priorities. Creating informed demand from communities also supports EIMC as a service delivery priority. Formative research shows that EIMC programs should address the fears and anxieties of parents so that they, especially fathers, understand the health benefits of EIMC before the birth of their babies.
The vast majority of public-sector facilities in Swaziland are led by nurses, and nurses and midwives have borne the brunt of caring for patients with HIV/AIDS in Swaziland. Like prevention of mother-to-child transmission, EIMC provides an opportunity for nurses and midwives to stand at the forefront of HIV prevention efforts. Rapid scale-up of VMMC and EIMC in Swaziland has the potential to avert more than 56,000 HIV infections and save US$370 million in the next 20 years.
斯威士兰王国政府认识到，必须紧急扩大艾滋病毒预防干预措施，例如自愿医疗男性割礼（VMMC）。斯威士兰采取了分两个阶段扩大男性割礼的方法。追赶阶段优先为青少年和成年人提供 VMMC 服务，而可持续性阶段则涉及早期婴儿男性割礼（EIMC）的建立。斯威士兰没有现代割礼传统，而且 VMMC 计划遇到了客户需求方面的挑战。但是，自 2010 年 EIMC 计划启动以来，斯威士兰现在在东非和南非地区扩大 EIMC 方面处于领先地位。在这里，我们回顾了斯威士兰的计划及其成功和挑战。
2014 年 2 月至 5 月，我们在编写斯威士兰“2014-2018 年艾滋病毒预防男性割礼战略和运营计划”时收集了数据。我们进行了结构化的利益相关者焦点小组讨论和深入访谈，并从负责 VMMC 和 EIMC 服务提供的实施伙伴那里收集了 EIMC 服务提供数据。数据以综合叙述的形式进行了总结。
在 2010 年至 2014 年期间，经过培训的提供者在斯威士兰的 11 个医疗保健设施中进行了 5000 多次 EIMC，并且他们没有报告中度或重度不良事件。根据广泛的 EIMC 计划利益相关者的说法，EIMC 计划需要设施、区域和国家领导的大力支持，包括艾滋病毒预防协调机构内外的支持，以促进制度化和所有权。斯威士兰 4 个地区医院中的 3 个的提供者和医疗保健管理人员建议，当 EIMC 引入生殖、孕产妇、新生儿和儿童健康平台时，专门的工作人员关注可以帮助确保在竞争的优先事项中进行 EIMC。从社区创造有针对性的需求也支持 EIMC 作为服务提供的优先事项。形成性研究表明，EIMC 计划应解决父母的恐惧和焦虑，以便他们，尤其是父亲，在婴儿出生前了解 EIMC 的健康益处。
斯威士兰绝大多数的公共部门机构都由护士领导，护士和助产士在斯威士兰照顾艾滋病毒/艾滋病患者方面承担了大部分工作。与预防母婴传播一样，EIMC 为护士和助产士提供了在艾滋病毒预防工作中处于领先地位的机会。斯威士兰 VMMC 和 EIMC 的快速扩大有可能在未来 20 年内避免超过 56,000 例艾滋病毒感染，并节省 3.7 亿美元。
