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Background: In response to recommendations by the World Health Organization, voluntary medical male circumcision (VMMC) services were launched in Zambia in 2009. Men opting to undergo VMMC are offered provider-initiated HIV-testing services (PITC) prior to circumcision. Scaling-up VMMC has the potential to increase population-levels of HIV-testing amongst all men, both directly (through the offer of PITC at VMMC services) and indirectly through normalising knowledge of ones HIV-status. The aim of this study was to assess how VMMC services contribute to uptake of HIV-testing among men.
Methods: We conducted an integrated analyses of programmatic data, systematic observations and population-based surveys, to describe VMMC service scale-up, including delivery, promotion and uptake, in 42 study sites in three districts. Using a 2013 population-based survey, we describe HIV-testing behaviours of men reporting circumcision between 2009 and 2013 and men reporting that they are not circumcised. We used cluster-level summary analyses to investigate whether VMMC scale-up was associated with higher levels of recent HIV-testing within 12 months prior to the survey.
Results: VMMC services were delivered in 62% (n=26) of study sites. Posters were observed in 58% (n=15) of sites where VMMC was delivered. No other promotional activities were observed in these sites. Between 2009-2013, 6% (n=138) of men were circumcised. Being recently circumcised was strongly associated with ever-testing for HIV, with 86% (n=118) of recently circumcised men ever-testing compared with 59% (n=1222; p< 0.01) of uncircumcised men. An estimated 45% (n=53/118) of circumcised men had HIV-tested before the year of their circumcision. The cluster-level mean of VMMC was 8% in sites where VMMC was delivered compared to 5% in sites where services had not. The cluster-level mean of recent HIV-testing was 33% compared to 30% (p=0.30), respectively.
Conclusions: VMMC scale-up has provided men with access to HIV testing services. Yet this study shows no evidence that scale-up is associated with increased population-levels of HIV-testing. This may be because relatively few men were circumcised and a high proportion had tested for HIV prior to being circumcised or because men in sites where VMMC services were not known to be delivered accessed services through alternate providers.

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