THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Using Non Physician Surgeons in Scaling up Safe Medical Circumcision (SMC) in Uganda: TASO Mbale Experience. Tumuheki M, Fomum E, Logose B, Babirye J; Okoboi S

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: The AIDS Support Organisation (TASO) Founded in 1987 by 16 individuals personally affected by HIV and AIDS Vision: “A world without HIV and AIDS” Mission: To contribute to the process of preventing HIV, restoring hope & improving the quality of life of PLWHA & their families.

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Background Uganda adopted Safe Male Circumcision as part of the broader strategies for HIV prevention in 2010 after; Several randomized clinical trials have proven that SMC prevents HIV transmission from females to males by 60% Uganda developed SMC implementation guidelines for enrollment and scale up of SMC services Uganda targets to circumcise 4.2 million (80%) adult males by 2015

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Background cont; Uganda has an estimated 4000 registered medical doctors (UMDPC, 2013) Doctor patient ratio is about 1:24,000 (HRHA Report, 2012) Scaling up SMC by Physicians to meet the target was challenging without task sharing and shifting. M.O.H-Uganda guided the training and use of non physician surgeons ( clinical officers, Nurses) to carry out SMC

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Description TASO SMC program was initiated in 2013 after trainings by ; Rakai Health Science Program (RHSP) in Rakai district Makerere University WALTER REED project in Kanyunga 2 weeks training involving both theories and much intensive supervised practicum Trained staff observed and practiced in hospitals under technical supervision by trainers

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Description cont… The teams were trained to handle emergency and resuscitation Mapping of all potential SMC camping sites and assessment of eligible site suitable for camping

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Monthly SMC outputs in Uganda

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: TASO Bi-annual SMC outputs TASO FacilityTotalNo. by site type No. by age group (in yrs) Adverse Events CircumcisedStaticMobile < >49MildModerateSevereFatal Bugembe HC IV Buwenge HC IV Lwanjusi HC III Magale HC IV Masindi Hospital TASO Entebbe TASO Gulu TASO Kanyanya TASO Masaka TASO Mbale TASO Mbarara TASO Rukungiri TASO Soroti Tororo Hospital

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: RESULTS Total number of 4679 males were circumcised (Jan 2013 to Dec 2013)

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: SMC in progress in community theatres

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Lessons learnt. Non –physician surgeons can scale up safe male circumcision in settings with inadequate physician surgeons to meet the set targets Non physician surgeons are available and willing to carryout SMC in rural communities compared to physician surgeons No major adverse events during and after surgeries were experienced

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: Next Steps HIV implementing partners can adopt this model to scale SMC to Public Health Facilities. Optimizing use of non-physicians to contribute to Uganda’s SMC targets

THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: /1, Fax Website: In Partnership With;