Application of an HIV Prevention Cascade to Identify Gaps in Increasing Coverage of Voluntary Medical Male Circumcision Services in 42 Rural Zambian Communities

Abstract

Increased coverage of voluntary medical male circumcision (VMMC) is needed in countries with high HIV prevalence. We applied an HIV-prevention cascade to identify gaps in male circumcision coverage in Zambia. We used survey data collected in 2013 and 2014/15 to describe circumcision coverage at each time-point, and prevalence of variables related to demand for and supply of VMMC. We explored whether circumcision coverage in 2014/15 was associated with demand and supply among uncircumcised men in 2013. Results show that circumcision coverage was 11.5% in 2013 and 18.0% in 2014/15. Levels of having heard of circumcision and agreeing with prevention benefits was similar at both time-points (79.8% vs 83.2%, and 49.7% vs 50.7%, respectively). In 2013, 39.3% of men perceived services to be available compared to 54.7% in 2014/15. Levels of having heard of circumcision in 2013 was correlated with and higher perceived service availability associated with coverage in 2014/15. VMMC coverage was low in these study sites. Knowledge of prevention tools and of service availability are necessary to increase coverage but alone are insufficient.

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Acknowledgements

The authors would like to express their gratitude to the men who participated in the surveys, and the BHOMA community survey team leaders and research assistants.

Funding

The BHOMA trial was part of the Africa Health Initiative launched by the Doris Duke Charitable Foundation (Grant# 2009060). Funding was provided by Economic and Social Research Council (Grant No. ES/J500021/1).

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Correspondence to Bernadette Hensen.

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Hensen, B., Fearon, E., Schaap, A. et al. Application of an HIV Prevention Cascade to Identify Gaps in Increasing Coverage of Voluntary Medical Male Circumcision Services in 42 Rural Zambian Communities. AIDS Behav 23, 1095–1103 (2019). https://doi.org/10.1007/s10461-019-02407-w

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Keywords

  • Voluntary medical male circumcision
  • HIV prevention cascade
  • Zambia
  • Africa
  • HIV