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Background: Tanzania is scaling up VMMC in 12 priority regions. USAID, through the AIDSFree project supports VMMC in three regions of Iringa, Njombe and Tabora. Approximately 500,000 VMMCs have been conducted in these regions to-date. WHO recommends clients return at 48-hours and 7-day post-circumcision to assess healing and reinforce HIV prevention messages including abstinence during healing. Ensuring high follow-up rates is challenging in rural settings. Various interventions were introduced to improve return visits. The analysis reviews follow-up rates in five years of program implementation.
Methods: De-identified data from the VMMC client-level database was reviewed from September 2009- September 2015. Analysis was performed on the follow-ups by year, age of clients and service modality. 48-hour and 7-day follow-up rates were calculated and statistical tests performed as appropriate.
Results: 497,259 clients received VMMC services from 2009-2015. Of these, 365,957 (73.5%) returned for the 48-hour visit and 170,268 (34.2%) for the 7-day visit.
For both visits, follow-up rates were slightly higher for 10-14 years olds (76.3% for 48hrs visit and 36.6% for 7-day visit) and lower amongst 15-19 year olds (68.8% and 30.8% respectively). The follow-up rates increased gradually with age in the age group >20 years (73.8% and 33.4% respectively) (p < 0.001). Follow-up rates were significantly higher during mobile services followed by campaigns and lowest in routine services (p < 0.001). There was a significant increase in the follow-up rates over the six-year program (figure 1).
Conclusions: Follow-up rates improved gradually over the six-year period. This improvement may be related to the mix of strategies deployed to improve follow up rates including: client education through a post-operative brochure, sending SMS reminders, special training to providers and data clerks on follow-up/AEs and use of data dashboards to improve services at site level. Cumulatively, these innovations may have improved the follow-up rates over time.

Follow up trend among VMMC clients in Tanzania
[Follow up trend among VMMC clients in Tanzania]

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