models to increase volumes and efficiency in zimbabwe’s male circumcision program k. hatzold 1, c....
TRANSCRIPT
Models to increase Volumes and Efficiency in Zimbabwe’s Male Circumcision program
K. Hatzold1, C. Samkange2, E. Fusire3, G.S. Dendere4, K. Kaseke1, D. Rech5, R. Dhlamini1,
G. Ncube6, O. Mugurungi6
Institutes: 1Population Services International Zimbabwe, Harare, Zimbabwe, 2University of
Zimbabwe College of Health Sciences, 3Zimbabwe Republic Police, Medical Department 4Air
Force of Zimbabwe, Medical Department, 5Population Services International, 6Ministry of
Health and Child Welfare Zimbabwe
Background• Adult HIV prevalence 13.7%• MC prevalence 10.3% • 750,000 HIV infections could be
averted if 80% of males are
circumcised• Goal to circumcise 80% of 15-29 year old males by
2015 (1.3 million) • Policy only allows doctors to conduct MCs • Completed 12 months pilot phase to test models of
service delivery, 6500 males circumcised over 12 months
• High latent demand for MC
MOVE Components • Forceps guided method
• Cost-effective, Safe, High outputs
• Diathermy for hemostasis
• Team of 2 doctors & 3 nurses serving 4 clients at one time
• Open plan operating room with several cubicles – Client flow– Quick movement between cubicles– Communication among team
• Disposable MC kits, hand scrub between clients
MC Client Flow
Client 1 Client 3
Client 2 Client 4
Surgical Team
Doctor 1
Doctor 2
N
N
N
A
A
A
A
S
S
S
S
Client 5
Results
Surgical Steps Time pre MOVE Time post MOVE
Pre-op assessment, scrubbing (Nurse) 5 min 5 min
Anaesthesia (Doctor) 2 min 2 min
Operating Time (Doctor) 25-30 min 7-10 min
Dressing and Cleaning (Nurse) 2 min 2 min
Cubicle Turnover Time 60 min 25-30 min
# of Clients per team 1-2 per hour 8-10 per hour
Next Steps • Multi-country operational research to
evaluate MC MOVE.
• Efficiency models used for expansion of MC services.
• Policy change towards task shifting of surgical components of MC to nurses.
page 7
Acknowledgments Partners • MOHCW Zimbabwe
– O. Mugurungi, G. Ncube
• C. Samkange, University of Zimbabwe• D. Rech, PSI
Donors:– USAID – UKAID
Implementers: • PSI MC team
– E. Fusire, G.S. Dendere, K. Kaseke, R.Dhlamini