Detailed Mechanism Funding and Narrative

Years of mechanism: 2013 2014 2015 2016 2017 2018

Details for Mechanism ID: 16804
Country/Region: Zimbabwe
Year: 2013
Main Partner: University of Washington
Main Partner Program: I-TECH
Organizational Type: NGO
Funding Agency: HHS/CDC
Total Funding: $4,450,000

The overarching goal of this program is to contribute towards a reduction in HIV incidence in Zimbabwe by scaling up voluntary medical male circumcision (VMMC). Intervention studies in multiple African countries have demonstrated that voluntary medical male circumcision can reduce a mans risk of acquiring HIV by 60%.Traditionally, Zimbabwe has not been a circumcising country, with only about 9% of the male population circumcised. Recent national data demonstrates an increase in HIV prevalence amongst adult males. The Zimbabwe Ministry of Health and Child Welfare estimates that achieving 80% VMMC coverage among all adult and new born males by 2015 could avert ~750,000 new infections by 2025. Currently, only about 91,000 VMMC have been conducted, and a mix of innovative approaches to rapidly increase demand and expand access to VMMC is needed to impact the epidemic.

The main objective of this program is to scale up VMMC services in selected provinces in Zimbabwe as part of a comprehensive HIV prevention package. The project will establish facility based VMMC sites in target provinces, train outreach teams to develop community-based campaigns to generate demand for VMMC and establish mobile or satellite VMMC sites. The target is to complete VMMC on 40,000 uncircumcised males aged 15-49 years in the 2013 financial year. Monitoring and Evaluation activities will be done through regular data collection and quality assessments and review of quaterly program reports. There will be dedicated staff to monitor and ensure quality service provision. Mid-term and end of program evaluations are planned

Funding for Biomedical Prevention: Voluntary Medical Male Circumcision (CIRC): $4,450,000

The purpose of this program is to scale up Voluntary Medical Male Circumcision as an evidence-based biomedical prevention intervention in Zimbabwe within the concept of combination HIV prevention strategies.

Zimbabwe has traditionally not been a circumcising country, with only about 9% of the male population circumcised. However, intervention studies done in recent years in multiple African countries have demonstrated that voluntary medical male circumcision (VMMC) can reduce a mans risk of acquiring HIV by 60%. In addition, although overall HIV prevalence among 15-49 year old males in Zimbabwe is 15%, the most recent Demographic Health Survey (2010-11) demonstrates dramatic increases in HIV prevalence from 3.4% among males aged 15-19 years to 29.9% among males 45-49 years of age. The Ministry of Health and Child Welfare (MOHCW) estimates that achieving 80% VMMC coverage among all adult and new born males by 2015 could avert ~750,000 new infections by 2025. Currently, only about 91,000 VMMC have been conducted, and a mix of innovative approaches to rapidly increase demand and expand access to VMMC is needed to impact the epidemic.

The first year of the project will focus on adult male VMMC service delivery scale-up in selected districts as determined by the Zimbabwe Ministry Health. Sites may be expanded or reduced in later years of project award. The aim is to establish 10 facility based VMMC sites within three months of commencement of activities and further create 25 mobile or satellite VMMC sites in targeted districts within the first year of implementation. Other strategies will include the establishment of 15 outreach teams mandated to develop community based campaigns aimed at generating demand for VMMC in addition to performing VMMC procedures. Vehicles will be purchased as needed to facilitate outreach.

By the end of the 2013 financial year, the target is to complete VMMCs on 40,000 uncircumcised males as part of a comprehensive HIV prevention package consisting of HIV prevention education, risk reduction counselling, HIV testing and counselling, provision of condoms, prevention with positives, etc. Males identified as HIV infected will be counselled and referred for further treatment. Dedicated staff will be assigned to each implementing district to monitor service provision and ensure quality. Monitoring and Evaluation activities will be done through regular data collection and review of quarterly program reports. Rigorous data will be collected on occurrence of any adverse events. Mid-term and end of program evaluations will be incorporated in the work plan .

The PrePex device was recently piloted in Zimbabwe and found to be safe for use in male circumcisions delivered by both physicians and nurses. It was also found to be highly acceptable as a circumcision method by participants in the study as well as their partners. Training on use of the device is anticipated to commence in the near future as part of the VMMC program, and once approval for PrePex use has been granted by the WHO, the country will be able to purchase devices using PEPFAR and other funding. This will be beneficial in further scaling up VMMC services as it will be possible to shift from a predominantly physician led to a nurse led program. With the necessary policy changes, the project will incorporate use of the PrePex device in both adults and adolescents.

Subpartners Total: $0
To Be Determined: NA
Cross Cutting Budget Categories and Known Amounts Total: $2,000,000
Human Resources for Health $1,000,000
Motor Vehicles: Purchased $900,000
Renovation $100,000
Key Issues Identified in Mechanism
Implement activities to change harmful gender norms & promote positive gender norms
Increase gender equity in HIV prevention, care, treatment and support