Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe

Figures & data

Figure 1. ZAZIC VMMC organizational model.

Table 1. ZAZIC training from October 2013 to March 2017.

Type of Training	Course length (days)	# Clinicians trained	# Non-clinicians trained	Total	% MC staff retention^a
Basic VMMC Training	6 days	354	0	354	77
VMMC forceps-guided training of trainers	9 days	10	0	10	80
VMMC forceps-guided training	6 days	115	0	115	60
Nurses’ conversion course	3 days	229	0	229	75
PrePex training	5 days	319	0	319	80
PrePex training of trainers	3 days	34	0	34	62
VMMC logistics training	5 days	23	49	72	79
Dorsal slit training of trainers	9 days	25	0	25	92
Dorsal slit training	6 days	178	0	178	84
M&E data management	3 days	39	48	87	65
Emergency patient management	2 days	45	0	45	89
Rapid HIV Testing	5 days	47	0	47	100
Demand Creation	2 days	0	945	945	80
Internal Quality Assessment	2 days	6	1	7	76
Infection control (autoclave)	1 day	21	7	28	100
Total		1445	1050	2495

^aTraining data extracted from the MoHCC TrainSmart training database, July 2017

Table 2. MOHCC fee for service structure, 2013–2015.

Recipient	Fee in $US
Doctor/circumciser	4
Nurse (up to 3 nurses)	3
Receptionist	1
Theater assistant	1
Health promotion officer	1.50
Driver	0.50
Community nurse	1.5
Pharmacy tech	0.50
Review nurse at rural health center	1
Volunteer health workers	1
Facility fee	3
Provincial office fee	1
Total	$25

Table 3. Moderate and severe adverse events and follow-up by month, October 2013 to September 2016.

	2013						2014
	October	November	December	January	February	March	April	May	June	July	August	September	FY14 Total
AEs	11	3	4	11	21	23	30	12	46	17	13	2	193
AE rate %	0.59	0.12	0.26	0.65	0.64	0.56	0.83	0.38	1.18	0.36	0.28	0.06	0.49
Total MCs	2047	2440	1505	2068	3579	4290	3937	3153	4049	4997	4568	3207	39,840
	2014						2015						FY15 Total
AEs	11	9	5	7	22	32	15	14	17	7	9	9	157
AE rate %	0.32	0.24	0.18	0.28	0.60	0.56	0.47	0.34	0.50	0.16	0.21	0.31	0.36
Total MCs	3496	3807	2653	2657	3879	6110	2952	4133	3505	4503	4352	2821	44,868
	2015						2016
AEs	6	7	11	4	9	39	14	22	15	28	20	8	183
AE rate %	0.17	0.17	0.34	0.15	0.22	0.82	0.45	0.49	0.24	0.50	0.27	0.10	0.33
Total MCs	3604	4047	3257	2634	4199	4737	3095	4485	6167	6021	7319	7717	57,282
	2016						2017
AEs	8	13	3	0	11	13							48
AE rate %	0.11	0.18	0.06	0.00	0.15	0.01							0.10
Total MCs	6957	7131	5068	4910	7559	12,789							44,414

Figure 2. Number of MCs conducted by ZAZIC across all sites by month, March 2013–March 2017.