Dissemination and implementation of an evidence-based voluntary medical male circumcision program

Despite compelling evidence linking voluntary medical male circumcision (VMMC) with 60–70% HIV risk reduction in sub-Saharan Africa, Zambian men have been especially reluctant to undergo VMMC. The Government of Zambia set targets for VMMC uptake and promoted community-level interventions. Spear & Shield (S&S) is an innovative, evidence-based, service program promoting VMMC uptake while ensuring both VMMC supply and demand. This study assessed the large-scale provincial rollout of the program (S&S2) utilizing the RE-AIM model for translating interventions into the community. The S&S2 study was conducted between November 2015 and December 2020, and sequentially rolled out over four Zambian provinces in 96 clinics; 24 observation clinics received VMMC training only. Local clinic healthcare workers were trained to conduct the VMMC procedure and HIV counselors were trained to lead S&S group sessions. Using the RE-AIM model, primary outcomes were: R each, the number, proportion, and representativeness of S&S attendees; E ffectiveness, the impact of S&S2 on VMMC uptake; A doption, the number, proportion, and representativeness of clinics implementing S&S2; I mplementation, fidelity to the S&S intervention manual; and M aintenance, the extent to which S&S2 became an element of standard care within community clinics. Initially, n = 109 clinics were recruited; 96 were sustained and randomized for activation ( Adoption ). A total of 45,630 clinic patients ( n = 23,236 men and n = 22,394 women) volunteered to attend the S&S sessions ( Reach ). The S&S2 program ran over 2,866 clinic-months ( Implementation ). Although the study did not target individual-level VMMCs, ~58,301 additional VMMCs were conducted at the clinic level ( Effectiveness ). Fidelity to the S&S intervention by group leaders ranged from 42%-95%. Sustainability of the program was operationalized as the number of CHCs initially activated that sustained the program. Intervention delivery ended, however, when study funding ceased ( Maintenance ). The S&S2 program successfully utilized the RE-AIM model to achieve study goals for implementation and dissemination in four Zambian provinces. Innovative VMMC programs such as S&S2 can improve the uptake of VMMC, one of the most effective strategies in the HIV prevention arsenal

Environmental health · Family medicine · Health services · Male circumcision · Population · Program evaluation · Psychological intervention · Representativeness heuristic · Cervical Cancer and HPV Research · Female Genital Mutilation/Cutting Issues · Genital Health and Disease · Medicine · Nursing · Psychology

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  Open Access•Ronald H Gray, Godfrey Kigozi et al.•The Lancet•2007

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  Open Access•Ryan Cook, Deborah L Jones et al.•AIDS and Behavior•2015

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  Russell E Glasgow, Edward Lichtenstein et al.•American Journal of Public Health•2003

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