Tools and Curricula

Guideline on the Use of Devices for Adult Male Circumcision for HIV Prevention

World Health Organization (October 2013).

This document from the World Health Organization (WHO) is meant to inform policy and decision makers, program managers, health care providers, donors, and implementing agencies as they consider the role of circumcision devices for adult males. Developed according to WHO standards and requirements, it provides recommendations that WHO prequalified male circumcision devices have been shown to be efficacious, safe, and acceptable for men 18 years and older in settings where they are used by health care providers, and where surgical back-up facilities and skills are available. The guideline considers two specific devices, an elastic collar compression device and a collar clamp device; there was not enough evidence to assess other devices. The document is intended to inform use of these devices for HIV prevention in public health programs in settings with high HIV prevalence and limited resources. It includes a review of the clinical evidence and also outlines programmatic considerations.

WHO Technical Advisory Group on Innovations in Male Circumcision: Evaluation of Two Adult Devices (Meeting Report)

World Health Organization (January 2013).

This report presents the background information and proceedings of the January 2013 meeting of the World Health Organization (WHO) Technical Advisory Group (TAG) on Innovations in Male Circumcision. The meeting focused on reviewing the clinical performance of two devices for adult male circumcision, ShangRing and PrePex. Data were insufficient to review other devices. In accordance with the WHO Framework for Clinical Evaluation of Male Circumcision Devices, staff compiled clinical data by reviewing all published information and contacting researchers evaluating the devices. Data were extracted into standardized formats and reviewed by the TAG for clarification and classification of adverse events, and across priority standardized outcomes: patient eligibility; successful circumcision; procedure time; time to complete wound healing; pain; and acceptability. The report includes summaries of the data used and key points raised by the TAG for each device. The meeting discussions also informed programmatic considerations included in WHO guidance and identified key information gaps and research needs.

Framework for Clinical Evaluation of Devices for Male Circumcision

World Health Organization (WHO, September 2012).

To support rapid scale-up of medical male circumcision (MMC) for HIV prevention in settings with high HIV incidence and low prevalence, WHO and other health agencies sought to identify technologies to make MMC more cost-effective, safer, easier to implement than surgical methods, and with a shorter recovery time. Regulations on approval of such medical devices for use outside the body may only call for limited clinical trials. However, since MMC is a public intervention to be used on a large number of men, circumcision technology should receive rigorous review. This framework outlines a progressive series of clinical studies to establish the safety, efficacy, acceptability, and clinical function of devices for medical male circumcision when used by trained, mid-level health care providers in public health programs in resource-limited settings. It is intended for use by product developers, clinicians involved in testing devices, regulators, program managers, and donors. The document also notes some regulatory and manufacturing considerations, bridging studies, and implementation studies' and provides information on monitoring programs.

Manual for Male Circumcision under Local Anesthesia

World Health Organization, Joint United Nations Programme on HIV/AIDS, and Jhpiego (2008).

This comprehensive manual describes the safest and most practical methods for male circumcision (MC) in resource-limited settings. It starts by describing the benefits and risks of MC, and how MC can be linked to other sexual and reproductive health services. The bulk of the manual provides technical guidance on the MC procedure, detailing the knowledge, skills, and attitudes providers need to safely carry out different procedures. Containing multiple photos and drawings, sample consent forms, information sheets for clients, stock cards, adverse event forms, the manual is an excellent training tool. It also contains chapters on counseling clients, obtaining informed consent for MC, preventing infection, managing complications, and running an MC service.

Male Circumcision Services Quality Assessment Toolkit

Ashton, J., & Dickson, K. World Health Organization. (2009).

This tool can be used to assess the quality of male circumcision (MC) services, guide service set-up, and improve existing services. In addition to measuring a site’s progress towards meeting standards, it can be used for certification or accreditation. It includes an outline of how the toolkit should be used, how often assessments should take place, and what should be done with the findings. The toolkit contains extensive checklists that can be used to assess everything from infection prevention and control to conducting the surgical procedures, providing counseling, and managing adverse events.

Male Circumcision Situation Analysis Toolkit

Budge-Reid, H., Schmid, G., et al. World Health Organization. (2009).

A situation analysis is crucial to developing safe male circumcision (MC) services. Such an analysis can help program planners understand the determinants and scale of MC practices; assess current capacity to perform safe MC; and determine whether community support exists for MC. This toolkit contains six tools that can be used to obtain a situation analysis from which to build a successful MC program. These tools provide guidance on desk reviews, key informant interviews, stakeholders’ meetings, focus groups, assessments of service availability, feedback, and action.

Considerations for Implementing Models for Optimizing the Volume and Efficiency of Male Circumcision Services (MOVE)

World Health Organization (2010).

This report outlines various considerations and options for organizing adult medical male circumcision (MMC) surgical services to improve efficiency and service volume while ensuring a safe service of high quality. It is a guide for both program managers involved in setting up or strengthening MC services, and funders and policymakers who need to make decisions about the costing and financing of MMC services.

A Guide to Indicators for Male Circumcision Programmes in the Formal Health Care System

Budge-Reid, H., Schmid, G., Samuelson, J., and Reed, J. World Health Organization and Joint United Nations Programme on HIV/AIDS (2009).

Indicators are needed to measure the degree to which an intervention or program is achieving its goals. This guide includes indicators related to creating demand for male circumcision (MC), generating supply for MC, and maximizing safer sexual behavior. When used, these indicators can help provide feedback for managing MC programs. Targeted indicators for indicators for advocacy include a strong policy component, and behavior/social change. Each indicator is described in detail, including what the indicator is intended to measure, recommended frequency of reporting, measurement tools needed, how the data will be collected, numerators, denominators, and how to interpret the indicator. Countries can choose to add specific indicators to their programs, or adapt them for use.

eLearning course: Male Circumcision: Policy & Programming

Curran, K., Njeuhmeli, E., and Merriman Davis, C. Jhpeigo and U.S. Agency for International Development (2011).

This three-hour e-learning course uses reviews the evidence about the protective effect of male circumcision (MC) on HIV transmission and presents available data on the acceptability and safety of MC. It also addresses program and policy issues, such as implementation challenges, and provides policy and program guidance. Developed for policymakers and program managers, this training focuses primarily on the public health issues related to MC. The course presents information on providing MC in both high- and low-prevalence settings. Modules include key information on commodities and supply chain management; counseling, communication, and demand generation; and the cost and impact of expanding MC on HIV incidence.

Male Circumcision Under Local Anaesthesia Course Workbook for Participants: Self-Paced/Individual Learning

World Health Organization, Joint United Nations Programme on HIV/AIDS, Maternal and Child Health Integrated Program) (n.d.).

This workbook is intended for use by health care providers who are being trained to perform male circumcision (MC) under local anesthesia. The innovative, flexible, competency-based course builds on an individualized assessment of knowledge and skills. The self-paced, individualized learning workbook is designed to be completed at the home facility over two to four weeks, and used in conjunction with classroom demonstration and coaching using anatomic models, simulation exercises, and clinic attachment. The course is meant to be flexible and adaptable while maintaining the standards of more formal training. It allows participants to move at their own pace, and enables both participants and trainers to spend less time away from their clinical duties, with less service disruption. The course is designed to build providers' capacity to provide MC-related services including describing the relationship of MC and HIV; linking with other male sexual and reproductive health services; counseling and screening adult and adolescent clients; building competency in one of the surgical methods of MC'; providing post-operative care, including managing adverse events; preventing infection; and monitoring, evaluating, and supervising a male circumcision service.

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