Background: Medical male circumcision (MMC) is an important HIV prevention strategy in Sub-Saharan Africa. In 2011, WHO/UNAIDS set the strategic goal of achieving "MC prevalence of at least 80% among 15-49 year old males" by 2016 in 14 priority countries, including Uganda. Reaching this goal requires monitoring and evaluation to assess program performance and identify subgroups with low coverage. Using population-based data in Rakai, Uganda, we estimated MMC coverage in men aged 15-49 years and by their demographics, risk profiles, and HIV serostatus from 2007 to 2014.
Methods: The Rakai Community Cohort Study conducts population surveillance of consenting residents aged 15-49 in rural Rakai every 12-18 months. MMC services were provided through randomized trials during 2004-06. Since 2007, free services were scaled up under PEPFAR funding. We used data from 30 communities consistently surveyed from 2007-2014. Each survey collected sociodemographic, behavioral, and health care seeking information, including self-reported circumcision status. Blood samples were collected for HIV testing. We estimated MMC coverage in all men and by subgroups. Chi-square tests were used to compare coverage by characteristics in each survey.
Results: Figure 1 shows MMC coverage in men and by non-Muslim men''s age, marital status, residence type, sexual behaviors, self-perceived risk of HIV exposure, and HIV status. From 2007-2014, coverage in all men increased from 28.5% to 52.0%. Coverage was initially lower in 15-19-years olds but increased in 2014. Coverage was consistently higher in married men and in urban communities, and lowest in men with no sex partners in the prior year. Coverage did not significantly differ by condom use, self-perceived risk of HIV exposure, or by HIV serostatus.
Conclusions: Increasing MMC coverage in all subgroups suggested that MMC became normative, but coverage fell short of WHO/UNAIDS target, indicating the need for demand generation to reach the 80% coverage goal.

Figure 1. MMC coverage in all men and by Non-Muslim men''s characteristics
[Figure 1. MMC coverage in all men and by Non-Muslim men''s characteristics]

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