Mobile Male Circumcision Services in the Lake Victoria Islands of Kagera, Tanzania: Mobile Male Circumcision Services in the Lake Victoria Islands of Kagera, Tanzania: Program Description and Achievements Abubakari Mwinyi, MD A collaborative work done by MOHSW, Kagera region, Muleba District and ICAP – Columbia University (Tanzania)

Description I Five rounds of mobile MC targeted 5 major islands with their satellites (about 20). In four rounds, medical tents designed for surgical services were utilized for MC surgery, and normal tents were used for education and counselling. The surgical team included 1 clinician and 6 nurses. Support staff included 3 additional nurses (HTC, group education/reception, post- operative), a data clerk and a community mobilizer.

Description II All the materials and supplies were ferried from the mainland two days prior to campaign. A generator was required for lighting and sterilization, and lake water was treated and used for non-drinking purposes. Local motor boats used to shuttle clients from satellite islands/centres to the MC services. Post-surgical follow-up (48hrs &7 days) was done at the MC site and through outreach to designated locations on nearby islands.

Island Total circumcised Campaign # days Average MC/day Bumbile Goziba Kerebe Ikuza Mazinga Days of mobile service, circumcisions done and average daily number of clients circumcised per island Age groupOverall Campaigns (5) <14 years31% % 26+29% Age distribution of registered clients

Summary Results Through 5 rounds of outreach services to Lake Victoria Islands, 4,259 men attended the MC clinic; 4,112 tested for HIV (97%) and 94% (n=3995) were circumcised. Follow-up visits were completed by 80% of MC clients at 48 hours. Only 14 moderate and 6 severe adverse events were reported. Over 17% of men >25 years tested HIV+. Recent (3 mos) risk behaviours among sexually active adults (15+) also were high: 36% reported to have exchanged sex for money, and only 35% reported using a condom for HIV prevention.

Lessons Learned Mobile MC services can be provided safely in remote areas with poor infrastructure and minimal health services. Disposable MC kits used in the last two rounds were superior to re-usable kits. Challenges : dangerous weather conditions, poor local motor boat conditions, and the absence of electricity and suitable housing for the provider team. Transport (boat rental, fuel) costs are high, but essential in order to ferry clients to services, and health workers to islands for follow-up care.

Acknowledgment All Male Circumcision clients Kagera RHMT, Muleba Local government Authorities MC Technical Working Group, Tanzania MOHSW- National AIDS Control Program CDC PEPFAR