Maintaining Voluntary Medical Male Circumcision (VMMC) services amid COVID-19 outbreak in Gambella Region, Ethiopia

BACKGROUND: VMMC reduces the risk of HIV acquisition for men by about 60% and is recommended as an additional option for HIV prevention. The federal ministry of health has prioritized VMMC in the Gambella region of Ethiopia which has the highest HIV prevalence (6%) and low rates of male circumcision (47%), setting ambitious doubling of VMMC targets from prior year to 40,792 from October 1, 2019 to September 29, 2020. We examined the effects of COVID-19 pandemic on these activities.
DESCRIPTION: By the end of March, the program had reached only 40.7% (16,604) of the annual target and then was paused due to COVID-19 outbreak for 20 and 53 days at public and refugee facilities, respectively. ICAP in collaboration with the Gambella Regional Health Bureau (GRHB) resumed VMMC activities using a phased approach, carefully weighing the risk and benefit on an ongoing basis. Prior registration and appointment system were introduced, infection prevention and control (IPC) supplies were distributed and triaging undertaken while adhering to mitigation measures. The program disseminated VMMC and COVID-19 awareness and prevention messages through posters, radio announcements and the community mobilizers.
LESSONS LEARNED: VMMC services resumed successfully despite the ongoing COVID-19 epidemic. By end of September 2020, 33,483 males were circumcised, 82% of the target, majority (77%) were in the priority age (15-29 years), and 98% returned for follow-up visit with low adverse event rate (0.39%).


CONCLUSIONS: Modifying demand creation approaches and establishing appointment systems with strict adherence to IPC practices enabled the maintenance of VMMC services during the COVID-19 outbreak.