The U.S. President’s Emergency Plan for AIDS Relief Title MALE CIRCUMCISION PROGRAM Emmanuel Njeuhmeli, MD, MPH, MBA Senior Biomedical Prevention Technical Advisor Co-Chair PEPFAR MC TWG USAID - Washington |Office of HIV/AIDS

PEPFAR MALE CIRCUMCISION PROGRAM PEPFAR supports MC as a component of a comprehensive HIV prevention program in sub-Saharan Africa, PEPFAR is working to scale up quality MC programs as feasible and appropriate to the country context. In its next phase, PEPFAR is transitioning to a two pronged MC assistance approach. This approach would simultaneously support the immediate demand for MC and allow governments to develop policies and the necessary infrastructure for more sustained service delivery.

Two pronged approach assistance Adult and Neonate Male Circumcision

PEPFAR Male Circumcision Future Directions Efficiency/Program productivity –Clinical/program efficiencies to boost productivity with given resources –Technical assistance visits –Evaluation of efficiency considerations (Operational Research) Accelerated ‘saturation’ of populations –Support to Swaziland to rapidly ‘saturate’ pops with MC –Greater reductions in HIV incidence as scale-up pace increases –Opportunity in Swaziland to demonstrate nationwide reductions in HIV incidence among men and women after ASI –Subsequently allows for resources to be dedicated to neonatal MC and other endeavors

PEPFAR MALE CIRCUMCISION BUDGET

TOTAL BUDGET BY COUNTRY

TOTAL BUDGET BY COUNTRY AND BY YEAR

PEPFAR MC Activities Advocacy Service delivery Communication Monitoring and evaluation Quality assurance Operational research Impact evaluation Every dollar need to translate into infection averted Every dollar need to translate into infection averted

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