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Background: Three randomized controlled trials have demonstrated that male circumcision reduces female to male heterosexual transmission of HIV by 60%. Since 2009, Tanzania has extensively scaled up voluntary medical male circumcision (VMMC). Early infant male circumcision (EIMC) is seen as a possible long-term, sustainable strategy for an AIDS-free generation. The more infants who are circumcised, the fewer adolescents and adults will need circumcision in the future. When compared to VMMC, EIMC requires less time, has a shorter healing period and may be more cost-efficient. Tanzania introduced EIMC as a pilot in 2013. Tanzania''s pilot used an integrated model of service delivery with EIMC services offered within existing Reproductive and Child Health (RCH) services.
Description: For the EIMC service, parents are educated about EIMC service during antenatal care (ANC), maternity and/or postpartum care as well as during well-baby visits. EIMC services are offered in the outpatient RCH clinic. Infants can be linked to other well baby services and parents are offered HIV testing and counseling. Infants that are HIV-exposed are linked to PMTCT services. Provider interviews were conducted to elicit their perspectives on the integrated EIMC service.
Lessons learned: Eight health facilities offer EIMC services as pilot sites in Iringa Region and a total of 57 health care providers were trained in EIMC provision with over 3,800 male infants circumcised as of December 2015. The RCH health care providers perceive EIMC as a good practice and EIMC being integrated within RCH reduces delays in EIMC service. However, during interviews conducted to elicit their perspectives on the integrated EIMC service, providers felt that their work responsibilities have changed since the introduction of EIMC services, noting that their workload had increased and their work plan or schedule had changed.
Conclusions/Next steps: Delivering EIMC services as part of an integrated RCH package was successful during the Tanzania EIMC pilot. RCH providers need support in time management and service efficiencies to streamline EIMC service delivery. Furthermore, a formal costing study using an integrated EIMC approach is needed to inform scale up of this service.