Richard G. Wamai, PhD Assistant Professor of Public Health Department of African American studies Northeastern University June 27, 2012

Efficacy of Current Interventions Sources: Wamai RG. Et al. JIAS Grant et al. NEJM 2010; Karim et al, Science 2010; Thigpen et al HPTN-START – Strategic Timing of Antiretroviral Therapy TDF2-Botswana

MC Scientific Evidence is Unequivocal  4 Ecological studies  35 Cross-sectional studies  14 Prospective studies  3 Randomized control trials  100s Reviews, systematic reviews and meta- analyses MC Protection rate = 60-80% Sources: Dickson K, Farley T. 2010; Wamai RG, et al. JIAS Morris BJ, Wamai RG. JAIDS. 2012

Sources: Morris BJ, Wamai RG. JAIDS. 2012

MC Acceptability, variable results Source: Morris BJ, Waskett JH, Banerjee J, Wamai RG., et al. A Snip in Time. BMC Pediatrics 2012

MC trends in the new-borns, US, SourceS: CDC. MMWR, 2011, Sep 2; 60:1167-8; Source: Smith KD et al CDC policy

18 US states have eliminated Medicaid funding for MC See: Source: Morris BJ, Waskett JH, Banerjee J, Wamai RG., et al. A Snip in Time. BMC Pediatrics 2012

MC Implementation in 14 SSA Countries, October 2011 Source: Wamai RG, et al. JIAS Distance to Goal

Source:

A march through Kisumu helped publicize the launch of the Rapid Results

VMMC Way Forward  Health provider training to be tailored to existing health systems and service structures – public & private (PPPs)  Efficiency Models for accelerating MC Model For optimizing The Volume and efficiency of MC Services (MOVE)- approach (S.Africa) Task shifting for nurses and clinical officers as per WHO Guidelines (Kenya and Zambia) RRI – Rapid Results Initiative (Kenya) Instrumentation: Devices that facilitate quicker and safer adult and infant MC Use of traditional circumcisers after proper training and provision of services in a culturally appropriate fashion  WTA – Conditional economic incentives to spur demand Source: Wamai RG, et al. JIAS. 2011

Think you are not at risk of HIV? HIV? Think Again, Again

15 Asanteni – Thanks