The effect of the two Tetanus Toxiod (2TT) dose policy on voluntary medical male circumcision (VMMC) service delivery in Masaka region, Uganda
Background: VMMC is a proven HIV
prevention intervention for men. Nine cases of tetanus infection that resulted
into 6 deaths were reported and MoH recommended 2TT doses 28 days apart before
circumcision.
We have observed a decline
in VMMC uptake which could affect cost per circumcision and the number of
infections that would be averted.
Modeling done in Rakai showed
that the number of surgeries required preventing one infection over 10 years
ranged between 19-58.
We assessed the effect of the 2TT dose policy
on VMMC uptake, cost per circumcision, and number of new HIV infections averted
over 10 years.
Methods: VMMC service data collected
between April and November 2016 from Masaka region was used for this analysis. Between
April and June (Period 1) all men received one TT dose and were circumcised on
the same day. The 2TT dose policy was fully implemented between August and
November 2016 (Period 2) and all men received 2TT doses before circumcision.
We used chi-square test to compare
VMMC uptake and cost per circumcision before and after the introduction of the TT
policy and estimated the number of new HIV infections that could occur over 10
years.
Results: Of all men who got TT1 in
period 1, 99.3% (15,211/15,317) were circumcised compared to 56.2%
(9,565/17,017) in period 2 (p< 0.0001).
During period 1 (TT1 only),
the total number of surgeries done was 15,211, an average of 5,070 circumcisions
per month. In period 2 (2TT doses), 9,565 circumcisions were done, an average
of 2,391 per month. The difference in monthly circumcisions between the 2
periods was 2,679 (52.8%) which translates into 10,716 missed circumcisions in
4 months and 32,148 in a year, despite availability of funds.
The operation cost per
circumcision in period 2 increased by 55% compared to period 1.
The number of HIV infections
that we would fail to avert over ten year''s range from 554 to 1,692.
Conclusions: In
Masaka region, the Ugandan TT policy led to a more than 50% reduction in the number
of men receiving circumcision, increased the cost per circumcision, and can reduce
the number of HIV infections averted.
N. Kighoma1, G. Nakigozi2, F. Nalugoda3, T. Murungi4, J. Mwenike1, M. Anyokorit1, S. Watya1,5, G. Kigozi1
1Rakai Health Sciences Program, Uganda Virus Research Institute, Studies, Kalisizo, Uganda, 2Rakai Health Sciences Program, Uganda Virus Research Institute, Clinical Services, Kalisizo, Uganda, 3Rakai Health Sciences Program, Uganda Virus Research Institute, Management, Kalisizo, Uganda, 4Rakai Health Sciences Program, Uganda Virus Research Institute, Data, Kalisizo, Uganda, 5URO CARE, Kampala, Uganda, Urology, Kampala, Uganda