The Bophelo Pele project (ANRS 12126) in Orange Farm (South Africa) Bertran Auvert INSERM CESP U1018 University of Versailles, France XIII International AIDS Conference Vienna, Austria 18-23 July 2010 Oral Poster presentation

Bophelo Pele project (ANRS 12126) Phase 4 study implemented in 2008 in Orange Farm, South Africa (HIV= 15.2% and male circumcision~15%) Provision of medicalized adult male circumcision (AMC) to all male residents aged 15 and older Objectives Establish a generalizable model for providing comprehensive, accessible and acceptable medicalized AMC services Investigate the feasibility AMC roll-out according to UNAIDS/WHO international recommendations and operational guidelines Circumcision center Mes travaux de recherche sont dans le cadre de l’etude Bophele Pele, qui signifie sante d’abord. Cette etude de phase 4 menee dans un township d’Afrique du Sud a pour objectif d’offrir a tous les hommes de la commnaute de plus de 15 and une circoncision gratuite. Logo 2 2

Bophelo Pele project: Activities Communication Radio Information sessions for and Community Engagement Household visits Distribution of brochures Recruitment Information visits Counseling for  and VCT les activites du projet sont des activites de communication et d’engagement de la communaute, de recruitement pour informer les potentiels participants en groupe et individuellement. Les circoncisions sont effectues par anesthesie locale avec des kits jetables. Le projet a trois equipes composees d’un circonciseur et 5 infirmiers (infirmieres). AMC Surgery (OMS) Disposable surgical kits Local anesthesia 3 teams of 1 medical circumcisers and 5 nurses ‘Task-sharing’ 3 3

Bophelo Pele project: Findings Consultations, discussions, CAB meetings, qualitative studies Project well accepted by the community and receiving good support Satisfaction survey in 2009 (N=1,158) Quality of services judged very good or good by over 92% of participants Audits, external and internal quality control, GCP audits Provision of high quality services by international standards Up to 150 AMCs can be performed per day, for an average circumciser time of 7.30 mins, a total procedure time of 20 mins and a cost of US$38 per AMC As of December 2009, 14,011 AMCs have been performed through the project (1.8% adverse events, no death nor permanent injuries) AMC uptake in the community: 39.1% L’evaluation du projet se fait par consultations et discussions regulieres avec les membres de la communaute, par etudes qualitatives, audits et controles de qualites internes et externes. On a aussi menee en 2009 une enquete se satisfaction parmi environ 1200 participants 4

Bophelo Pele project: Conclusions A quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines Along with similar ongoing interventions in the region (Kenya, Uganda) the project shows that AMC scale-up is a promising prevention method to fight the HIV epidemic in targeted communities of Southern and Eastern Africa Next step Assess the impact of AMC intervention on Knowledge, attitudes and practice regarding AMC Sexual behavior and condom use Spread of HIV and other STIs at the population level

Acknowledgements Orange Farm population (South Africa) Bophelo Project team (South Africa) ANRS (France) Progressus (South Africa) SFH (South Africa) NICD – NHLS (South Africa) University of Versailles (France) INSERM (France)