1. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

2. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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.

3. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

4. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

5. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

6. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

7. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org Monthly SMC outputs in Uganda

8. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org TASO Bi-annual SMC outputs TASO FacilityTotalNo. by site type No. by age group (in yrs) Adverse Events CircumcisedStaticMobile <1313-2526-49>49MildModerateSevereFatal 70352626440914944520955663210 Bugembe HC IV382613936870303278953130 Buwenge HC IV1661415124601384259181500 Lwanjusi HC III5204141064135611940000 Magale HC IV00000000000 Masindi Hospital426232021060263450771151110 TASO Entebbe462 0033912210000 TASO Gulu929 0081910550010 TASO Kanyanya453446703718200000 TASO Masaka720 026774100510 TASO Mbale24394971942872100227250400 TASO Mbarara28128010279200000 TASO Rukungiri12901275150113815021200 TASO Soroti693 0355797900000 Tororo Hospital876310117752166815544022113820 262991048315816357226793186772715680

9. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org RESULTS Total number of 4679 males were circumcised (Jan 2013 to Dec 2013)

10. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org SMC in progress in community theatres

11. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

12. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org 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

13. THE AIDS SUPPORT ORGANIZATION TASO TASO Uganda (Ltd). P.O Box 10443, Kampala Tel: +256 414 532580/1, Fax +256 414 541288 Email: mail@tasouganda.org. Website: www.tasouganda.org In Partnership With;