1. Determinants of VMMC Provider Burnout in 4 Sub-Saharan Countries Bertrand J 1, Rech D 2, Njeuhmeli E 3, Castor D 3, Frade S 2, Loolpapit M 4, Machaku M 5, Mavhu W 6, Perry L 1 Presented by: Dino Rech, M.D. Co-PI SYMMAC Medical Director, CHAPS 1. Tulane University, New Orleans, Louisiana, United States of America, 2. Center for HIV/ ADIS Prevention Studies, Johannesburg, South Africa, 3. United States Agency for International Development USAID, Washington, District of Columbia, United States of America, 4. Family Health International (FHI) 360, Nairobi, Kenya, 5. Maternal and Child Health Integrated Program (MCHIP) JHPIEGO, Dar Es Salaam, Tanzania, 6. Zimbabwe Aids Prevention Project (ZAPP)

2. Level of burnout among providers 2 Kenya (n=85) South Africa (n=105) Tanzania (n=93) Zimbabwe (n=74) Total (n=357) % who agree or strongly agree that “performing (or assisting in performing) VMMC is a personally fulfilling job” 87.1***82.9***100.0**81.1***88.0*** % who agree or strongly agree that “I personally have begun to experience work fatigue or burnout from performing (or assisting in performing) VMMC repeatedly.” 70.6***36.2***53.8***27.0***47.1*** The Systematic Monitoring of the Male Circumcision Scale-up (SYMMACS) is a two year study designed to track VMMC service delivery. Visits to 73 sites from Kenya, South Africa, Tanzania and Zimbabwe and interviews with 357 VMMC providers in 2011 Providers reported on levels of job satisfaction as personal experience of burnout and the frequency of burnout among their colleagues Levels of personal job satisfaction and burnout among VMMC providers in Kenya, South Africa, Tanzania and Zimbabwe (* α <0.05, ** α <0.01, ***α <0.001)

3. Results: provider cadre and time until burnout 3 Country: South AfricaZimbabwe Total Cadre of provider: MD n=21 Non MD n=84 MD n=19 Non MD n=55 MD n=40 Non MD n=139 % who agree or strongly agree that “performing (or assisting in performing) VMMC is a personally fulfilling job” 76.284.573.783.684.275.0 % who agree or strongly agree that “I personally have begun to experience work fatigue or burnout from performing (or assisting in performing) VMMC repeatedly.” 47.633.336.823.642.529.5 Levels of job satisfaction and burnout among Medical Doctors and non Medical Doctors in South Africa and Zimbabwe Percent of Providers reporting burnout by # of VMMCs performed Percent of Providers reporting burnout by months working in VMMC

4. Conclusions 4 Burnout is affecting VMMC providers in all four countries. Burnout increases over time with a spike in the period of 4-6 months. Extra measures to motivate staff during these periods could be especially beneficial. Lower job fulfillment and higher burnout among MDs encourages further research into the feasibility of implementing task-shifting to allow nurses to perform VMMC in South Africa and Zimbabwe. Differences between countries encourage further exploration of programmatic elements which may influence burnout (ie. Electrocautery, and VMMC kits). SYMMACS 2012 results should be used to validate the 2011 findings and show differential results over time. These results can inform human resource policies and program planning for VMMC as well as other clinical HIV services.

5. 5 The USAID | Project SEARCH, Task Order No.2, is funded by the U.S. Agency for International Development under Contract No. GHH-I-00-07-00032-00, beginning September 30, 2008, and supported by the President’s Emergency Plan for AIDS Relief. The Research to Prevention (R2P) Project is led by the Johns Hopkins Center for Global Health and managed by the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (CCP).