Developing a new service delivery model for male circumcision services in Swaziland

This study aims to develop an integrated male circumcision service in Good Shepherd Hospital and for the Lubombo region of Swaziland.
Swaziland has one of the most severe HIV epidemics in the world, with an estimated prevalence of 26% for adults aged 15-49. In 2007, the WHO advocated that male circumcision should be incorporated into HIV prevention measures in countries with low circumcision and generalised epidemics, including Swaziland. This recommendation came after 3 randomised controlled trials showed that male circumcision can reduce HIV transmission by 38% – 66%.
Male circumcision as HIV prevention was introduced to Swaziland in 2009, initially using an integrated approach to HIV prevention. In 2011, an intensive campaign, Soka Uncobe (circumcise and conquer), was launched, aiming to circumcise 80% of males within 1 year. The campaign had limited success, with less than 10% of males being circumcised during the year. Stand-alone campaign clinics are still operational, however, no services provide a fully integrated model of male circumcision for HIV prevention within Swaziland.

  • Establish a model for an integrated male circumcision service within a rural hospital, and for the surrounding region
  • Evaluate whether an integrated or stand-alone clinic model of male circumcision service is a more effective method for increasing overall numbers of male circumcisions for hospital services in Swaziland

Study outcomes
The study will compare an integrated model of delivery with a stand-alone clinic over 6 months, comparing numbers of males circumcised, proportions receiving counselling, post-operative follow up, complication rates and patient satisfaction.
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