Ashengo, T.A., Hatzold, K., Mahler, H., et al. PLOS ONE (May 2014), 9(4): e83642, doi: 10.1371/journal.pone.0083642.
This article described how different delivery modalities and intensity of VMMC services influenced the number and age of clients reached. National and service delivery data from 2009–2012, a period of rapid expansion of VMMC services in Tanzania and Zimbabwe, were supplemented with key informant interviews. Efforts to increase uptake of VMMC included diversified service outlet types (fixed, outreach, or mobile) and campaigns to supplement routine services. In Tanzania, service modality was associated with age: most clients (59%) receiving VMMC during campaigns were young (10–14 years), and most (64%) coming to routine VMMC services were age 15 or older. In Zimbabwe, significantly more VMMCs were done during campaigns (64%) than during routine service delivery (36%). In both countries, service modalities and intensities influenced the profile of clients served. The authors noted that some of this effect may be due to contextual factors. The countries were at different stages of VMMC scale-up. Most men in Tanzania (80% in most regions) are circumcised, generally during adolescence; peer pressure may have played a role. Zimbabwe did not have a tradition of male circumcision, and many campaigns were implemented during school holidays. Given these complex and specific dynamics, the authors recommended that VMMC programs integrate formative research to inform context-specific approaches to service delivery.