1. Models to increase Volumes and Efficiency in Zimbabwe’s Male Circumcision program K. Hatzold 1, C. Samkange 2, E. Fusire 3, G.S. Dendere 4, K. Kaseke 1, D. Rech 5, R. Dhlamini 1, G. Ncube 6, O. Mugurungi 6 Institutes: 1 Population Services International Zimbabwe, Harare, Zimbabwe, 2 University of Zimbabwe College of Health Sciences, 3 Zimbabwe Republic Police, Medical Department 4 Air Force of Zimbabwe, Medical Department, 5 Population Services International, 6 Ministry of Health and Child Welfare Zimbabwe

2. 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

3. 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

4. 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

5. Results Surgical StepsTime pre MOVETime post MOVE Pre-op assessment, scrubbing (Nurse) 5 min Anaesthesia (Doctor)2 min Operating Time (Doctor) 25-30 min 7-10 min Dressing and Cleaning (Nurse)2 min Cubicle Turnover Time 60 min 25-30 min # of Clients per team 1-2 per hour8-10 per hour

6. 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.

7. 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