Data from the recently completed randomized clinical trial in Orange Farm, South Africa showing a 76% protective effect against HIV infection in circumcised men has attracted attention from public health practitioners. Male circumcision is now viewed as a potential intervention that may be added to HIV prevention efforts particularly in developing countries. Decisions on whether to recommend male circumcision as a HIV prevention strategy await results from two ongoing trials of HIV acquisition in circumcised men and one trial of male-to-female transmission in Uganda and Kenya. As the results from the remaining trials are awaited, public health leaders are preparing for an anticipated rollout of endorsed male circumcision practices. As some of the awaited results will come from Uganda, and since the GOU has identified an urgent need to accelerate prevention efforts, it is timely for the USG to support some formative research on male circumcision to facilitate the implementation of policies and programs, in the event of global endorsement of male circumcision as an HIV preventive measure.

In consultation with the USG team, the MOH, the Uganda AIDS Commission and other local implementation partners in Uganda, FHI will design and implement a formative needs assessment to generate strategic information that will facilitate and support the design and implementation of a quality and cost-effective male circumcision intervention for HIV prevention. Results from this activity will complement other ongoing or planned international and regional efforts to prepare for the introduction and roll out of male circumcision as an HIV prevention intervention. Toward this end, it is proposed that FHI conduct a needs assessment and gather strategic information at the policy, program design, service delivery, community and client levels. This will involve the use of qualitative data collection approaches to gather and synthesize information relevant to the introduction and roll out of a public sector male circumcision strategy. Current policies will be reviewed to identify gaps that may hinder the implementation of this strategy at a scale where it will have a meaningful impact. Service delivery infrastructure, staffing and commodity needs will be assessed to identify gaps that need to be addressed prior to the implementation of large scale male circumcision intervention. At the community level, key informants (including men, women, traditional circumcisers, religious leaders, opinion leaders) from communities that practice circumcision as part of their tradition and those that do not will be interviewed using in-depth interview techniques to establish any socio-cultural barriers that may inhibit or facilitate the implementation of a male circumcision intervention. These data will be analyzed and packaged for use as advocacy tools at the policy, program and community levels. The data will be shared with all key stakeholders for use in their policy and program formulation.

It is expected that this activity will generate strategic information that will facilitate and inform the timely development of quality and cost-effective male circumcision interventions in Uganda and the region. In addition, data generated from this USG supported activity will complement other ongoing or planned international and regional efforts to prepare for the introduction and roll out of male circumcision as an HIV prevention intervention. For example information generated will inform efforts by UNAIDS to inform the roundtable discussions they are holding in some countries within Africa. In addition, a male circumcision consortium (MCC) has been formed and is preparing a proposal to be submitted to the Gates Foundation to support preparations in Africa for the potential introduction and roll out a male circumcision strategy.

Therefore data gathered through this needs assessment would contribute greatly to this process and continue to position Uganda at the forefront of HIV/AIDS prevention efforts in Africa.

OGAC Review: #9097 (FHI) The activities noted in the narrative overlap with activities that have been untaken by UNAIDS already. Please describe how this activity is complementary to the UNAIDS activities in this area and how this is coordinated.

We are not aware of any activities being undertaken by UNAIDS in this area at the present time, however we are closely engaged in the National Prevention Working Group to discuss collaboration. We are awaiting results of the trial in Rakai being supported by NIH and are fully aware of NIH plans for dissemination of results.

plus ups: Family Health International (FHI) will undertake a comprehensive assessment of preparedness for medical male circumsision at the facility and the community levels to

inform policy and program roll out. FHI will use the WHO developed needs assessment guidance and forms as these become ready.