1. Male Circumcision for HIV Prevention in Kenya: Service Delivery beyond Nyanza
Dr Peter Cherutich, MD, MPH
Deputy Director
National AIDS/STD Control Programme
(NASCOP)
Male Circumcision Meeting, Arusha 2010

2. 2007 KAIS: Male circumcision and HIV
National HIV Prevalence: 7.1%
National MC Prevalence: 85 %
With the evidence that has accumulated over several years, Nyanza province still has a low coverage of voluntary medical male circumcision.
Province with the highest HIV prevalence (Nyanza) has the lowest MC level
Province with the second highest HIV prevalence (Nairobi) has second lowest MC level

3. The VMMC Journey….. Sept 06 Nov 06 Dec 06 Feb 07 Mar 07 May 07 Aug 07
Kisumu trial stopped, DMS gives press statement
1st Kenya HIV Prevention Summit, Kisumu results shared
1st Kenya MC stakeholder meeting
DMS approves Policy on Male Circumcision
Sept 06
Nov 06
Dec 06
Feb 07
Mar 07
May 07
Aug 07
Sept 07
MC Taskforce recommends to DMS Policy on Male Circumcision
ESA Africa Consultation Meeting on MC in Nairobi
Kisumu results published in the Lancet 2007; 396:643–656.
WHO/UNAIDS endorse MC at Montreux
Dr. Mores & the MCC team

4. … The VMMC Journey Jan 08 Mar 08 April 08 Jul 08 Sept 08 Oct 08 Nov 08
MC RRI in 11 districts
Over 35,000 men circumcised in 30 days
Policy for MC in Kenya published
Task force reconvenes on 30th January
Consultation meeting with LCE in Oyugis
Letter from LCE to DMS
2nd Kenya Prevention Summit
2nd Stakeholder meeting in Nyanza
Announcement by GOK of National MC Programme
Jan 08
Mar 08
April 08
Jul 08
Sept 08
Oct 08
Nov 08
Jun 09
Nov 09
Ministry allows nurses to perform MC
Nyanza health facility assessment completed
Mbagathi:
working meeting for subcommittees
Creation of Nyanza Provincial MC Taskforce
1st Stakeholder meeting in Nyanza

5. VMMC policies and Guidelines
MC policy guidance
Clinical Manual for MC under LA
MC 5 year strategy in line with KNASP III
MC communication strategy
MC M&E tools 5 5

6. MC Scale up – Need Nyanza 1,239,040 640,584 480,438 Rift-Valley
Province
Est. Adult pop. (15-49)
Est. Adult Uncircumcised 15-49
Est. demand based on 75% acceptability
Nyanza
1,239,040
640,584
480,438
Rift-Valley
1,972,960
238,728
179,046
Nairobi
887,920
161,601
121,201
Western
880,000
106,480
79,860
Coast
667,920
18,702
14,026
Eastern
1,214,400
44,933
33,700
Central
1,020,800
46,957
35,218
North-Eastern
317,680
9,213
6,910
Total
8,200,720
1,267,187
950,398
Looking at all provinces, the over 1.2 M males (15-49) year olds is an under estimate. If we included year old, this # is much higher, requiring more funds. On average, we will need 200,000MCs per year to undertake these, and assuming average cost of $70/MC, we may be talking of close to $15M/year on average. 6

7. MC TARGETS BY REGION AND TIMELINE (TO REACH 80% AMONG CURRENTLY NON-CIRCUMCISED AND 94% NATIONALLY)7

8. Nairobi Metropolitan Cosmopolitan-high demand for VMMC
Facility assessments done
Engagement of various stakeholders
Technical
Political
More partnerships are being established

9. Western Province
Pockets of non-circumcising communities bordering Uganda-Teso and Samia
GoK through support from World Bank
Plan to offer 5000 MCs by end 2010
Preparatory activities and training ongoing
Service delivery to start July 2010

10. Rift-Valley Province
Around Lake Turkana and diaspora of non-circumcising communities
Very encouraging support from political, religious and government officials
Plans underway for a dedicated partners to start routine service delivery
Various partners are already working among circumcising communities e.g Walter Reed

11. MC Achievements versus Targets in VMMC strategy
Targets
Achievement*
Nyanza
76,500
90,000
Rift Valley
28,500
400
Nairobi
19,500
900
Western
12,000
Nil
Others
13,500
Nil 
Total
150,000
91,300 (60.8%)
The MC strategic plan and KNASP III highlights annual targets for the nest 5 years. This recognizes high initial start up costs, even though fewer targets will be achieved. Hoping that optimal performance of over 200,000 MCs will be done through out Kenya by the 3rd year.
Cumulatively 120,000 MCs have been done 11

12. Quality assurance 2 EQA visits-April and November 2009
National government led Quality Improvement Team established
Local Training done, domestication in process
QI teams in 3 districts

13. Key Challenges Coordination and mobilization of partners
Rationalization of partners, no new partners
Targeting resources to those in greatest need
Potential replacement of out-of-pocket MCs service
Matching supply and demand
Ensuring efficiency is the guiding principle
Vertical versus integrated approach
Reaching older men!

14. Opportunities World Cup 2010
Revitalization of male reproductive health
Community health strategy
Improves access
Synergies with other programmes e.g HIV testing and counselling
Sustained political and technical leadership
MC now widely accepted across communities

15. Ahsante! 15

16. Acknowledgements VMMC Taskforce Male Circumcision Consortium USG
FHI
NRHS
Engender Health
USG
Gates Foundation
UN family