CHAPTER 6. Providing the VMMC Minimum Package of Services

CHAPTER GOALS

To ensure site staff are able to:

  • Provide clients with all components of the VMMC service package, in accordance with national, World Health Organization (WHO) and U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) recommendations.
  • Provide VMMC services that are compliant with PEPFAR policies.

WHAT USERS NEED TO KNOW

WHO recommends that all clients receiving VMMC service receive a comprehensive package of services to support HIV/STI prevention or care and safe recovery [See WHO Manual for Male Circumcision Under Local Anaesthesia, 1st edition and PEPFAR Technical Considerations for COP/ROP 2016]. The “minimum package of services” (see Figure 6.1 by downloading the chapter PDF below)—which should be available to all VMMC clients at all sites—includes: 1) optional HIV testing and counseling services for all male clients and, where possible, their partners; 2) active referral of clients determined to be HIV-positive to HIV care and treatment programs, including determination of successful linkage 3) age-appropriate sexual risk reduction counseling, including recommendations for abstinence during wound healing; pre-procedure clinical screening (focused physical exam and medical history) to detect sexually transmitted infections (STI) and contraindications to circumcision; 4) screening and treatment of STIs; 5) circumcision by a medical method approved by WHO; 6) post-procedure follow-up, including systematic assessment of adverse events and, 7) provision and promotion of correct and consistent use of condoms, preferably both male and female condoms.

To ensure high quality VMMC services, the VMMC team in general and providers in particular must be competent in assessing clients for VMMC eligibility including evaluation of clients for tetanus immunity or vaccination against tetanus in countries where it is appropriate [See WHO Guidelines on Tetanus and VMMC July 2015 and September 2016] use of at least one WHO-approved VMMC method; anesthetic dosing (by use of weight based dosing anesthetic charts or calculation of an appropriate minimum dose) and adequate infection control practices [See Chapter 9]. This chapter describes the WHO comprehensive package of services including what providers need to consider as they attend to VMMC clients from client screening, through the procedure, recovery and follow up.

CASE STUDIES

TOOLS, INSTRUMENTS & GUIDANCE DOCUMENTS

  1. WHO Manual for Male Circumcision Under Local Anaesthesia, 1st edition
  2. PEPFAR Technical Considerations for COP/ROP 2016
  3. Guidance on Provider-Initiated Testing and Counseling in Health Facilities
  4. VMMC In-Service Communication: Best Practices Guide
  5. Guidelines for the Management of Sexually Transmitted Infections (STIs)
  6. PrePex Instructions for Use
  7. ShangRing Instructions for Use
  8. PEPFAR Country/Regional Operational Plan (COP/ROP) Guidance 2017
  9. WHO PQ PrePex Abstract
  10. WHO PQ ShangRing Abstract
  11. Use of Devices for Adult Male Circumcision for HIV Prevention in East and Southern Africa
  12. Technical Consultation Update to the WHO March 2015 Meeting—WHO Informal Consultation on Tetanus and Voluntary Medical Male Circumcision
  13. 2015 PEPFAR Reporting Protocol for VMMC Client Death and Notifiable Adverse Events (Can be obtained by contacting in-country USAID Mission staff.)

To see charts, graphs, and read additional information, download the chapter PDF.