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Monday, February 2, 2015

Will Rwanda be a Circumcised Nation by 2015?

By Esther Nakkazi
Rwanda faces a daunting task of hitting a target of 700,000 Voluntary Medical Male Circumcision (VMMC) procedures by mid 2015.

Rwanda, plus twelve other developing countries, in which prevalence of HIV is high and circumcision is low, were identified as a priority, where innovative approaches to scale-up are currently being explored.

The 13 priority countries, were identified by the World Health Organisation (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to scale up in an action plan that aims to reach 80 percent coverage of VMMC by 2015. 

If these procedures are carried out by the end of this year, the target of reaching 20 million adult VMMC will be achieved plus 3.36 million new infections will be averted at a cost of $16.5 billion.

As of 2010, only 2.7 percent of the total number of the VMMC procedures needed to reach the anticipated target had been performed. Many countries still have challenges of lack of infrastructure, a limited number of health workers, and funding.

The biggest question now is how many countries among the 13 WHO recommended countries will be able to achieve the given target by the end of this year?

By 2010, Kenya, was on track to achieve the 80 percent coverage by 2010 and Uganda if not for a lack of funding would also hit this target, because the Ministry of Health says if they have the money one million men will be circumcised this year.

To hit this set target, the Ministry of Health in Rwanda, factoring in limited resources and skilled health workers, is using PrePex (Circ MedTech Ltd, Israel), a non surgical device, for all adult men seeking VMMC.

Ministry of health officials think the device will accelerate the pace of service delivery, scale up programs and maximize the impact of the intervention.

Voluntary medical male circumcision has been conclusively demonstrated to reduce the lifetime risk of male acquisition of HIV by about 60 percent and a component of a comprehensive strategy towards achieving an AIDS-free generation.

The PrePex device is an FDA-approved and WHO pre-qualified non-surgical device. It works by compressing the foreskin and cutting off blood circulation, after which the distal foreskin becomes necrotic, permitting easy and bloodless removal after 1 week.

In the PrePex procedure, injected anaesthetic or sutures are not necessary, and skilled health workers who are trained and certified can perform the procedure in a clean, non-sterile setting. Procedure time with the PrePex device is five times faster than with the surgical technique, and the procedure is also safer.

In Rwanda, surgical male circumcision will only be reserved for men who are not eligible for PrePex or for males under the age of 18 years.

But the country, made a target of having its entire male population, eligible for circumcision by 2015, circumcised, which requires a bold strategy that focuses on the efficiency of task-shifting, judicious use of resources, and the leadership of civil society.

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