1. Dr. E. Odoyo-June Early Infant male circumcision in Nyanza Province, Kenya UNIM Project Nyanza Reproductive Health Society

2. Kenya’s VMMC program is expanding towards initiating MC services for infants aged 0-60 days A pilot infant MC project was initiated in Sep 2009 by NRHS under the auspices of the MCC –Mtoto Msafi Service providers in public health facilities are trained and supported to provide infant MC using Mogen clamp Uptake and safety are monitored through an inbuilt operational research to inform future roll out Introduction

3. Why emphasize Early Infant Male Circumcision ? Less technically challenging (no routine suturing) Minimal bleeding Faster Less expensive Intervention before the onset of sexual activity Rapid healing Lower complication rate (studies from North America)

4. “Mtoto Msafi” Early infant MC Research

5. “Mtoto Msafi” Early infant MC Research ? Goals: (1) Evaluate demand (2) Learn about parental decision making around EIMC (3) Assess safety Parents (mothers and fathers) of 600 infants eligible for IMC -- 300 accepting and 300 refusing Administer questionnaire Those in the circumcising group return for review

6. Comparison of demographic characteristics among parents who choose and those who decline EIMC Comparison of beliefs and attitudes about circumcision between the two groups Frequency, severity and type of AEs encountered Comparison of circumcision preferences of mothers to those of fathers Outcomes of interest

7. Current status 2 EIMC trainers certified 33 Nurses and RCOs trained in EIMC and 11 certified Service provided at 1 Provincial and 3 District Hospitals Expansion to two additional health facilities planned

8. Summary data SiteStart DateEIMC’s DoneUptake (%) NYANZA PGHSep, 2009253 14.6 KISUMU DHOct, 20098211.3 KOMBEWA DHNov, 20093221.3 SIAYA DHFeb, 2010116.8 381 Procedures performed by Mid May 2010 Total AEs= 5 (1.3%); 4 classified as mild intra operative bleeding and 1 involved post-operative bleeding Infants seen for follow-up = 207 (54.3%)

9. Challenges Relatively low uptake Turn away infants aged greater than 60 days Concerns regarding the timing and feasibility of rituals for infant MC Poor compliance with instructions on follow up visit desire for compensation by MOH staff for additional work

10. Mtoto Msafi research team led by Marisa Young Male Circumcision consortium Nyanza provincial MC task force Mtoto Msafi Project Staff Nyanza Provincial Hospital Kisumu District Hospital Kombewa District Hospital Siaya District Hospital Study participants Acknowledgements

11. Citations  EIMC is not widely practiced in Eastern and Southern Africa  IMC could be an acceptable HIV prevention strategy 1  Factors influencing decision making around IMC and true acceptability of IMC in Sub-Saharan Africa not Known  AE rates reported in the literature vary widely (e.g. 3% and 20.2% from 2 separate studies in Nigeria alone) 2,3 1 Westercamp, N and RC Bailey. 2007. Acceptability of Male Circumcision for Prevention of HIV/AIDS in Sub-Saharan Africa: A Review. AIDS Behav 11:341– 55 2 Ahmed, A, NH Mbibi, D Dawan, et al. 1999. Complications of traditional male circumcision. Ann Trop Paediatr 19:113-17. 3 Okeke, LI, AA Asinobi, OS Ikuerowo. 2006. Epidemiology of complications of male circumcision in Ibadan, Nigeria. BMC Urol 6:21