Dr. Dirk Taljaard. Activities Service delivery Training Technical Assistance Start-up teams Research.

Dr. Dirk Taljaard

ActivitiesActivities

Service deliveryTrainingTechnical AssistanceStart-up teamsResearch

Service Delivery:Number of MC in OF since Jun ‘10

Orange Farm (Linked Site)Zola, Soweto (Integrated Site)

New site in Pretoria (Linked Site)

Service Delivery:Sites

We have trained public and private sector

Training 4-5 Doctors/Nurses per week

60 Doctors 120 Nurses in KZN (Not the full course)

Capacitated NGOs or assisted them (PHRU, SFH, MatCH)

Training:

Clinical:Doctors

TheoryPracticals

Nurses – Professional – BlockingSuturing

Nurses – AuxiliarySurgery dutiesFollow-up PHC

Training:Courses

NDOHProvinces:

GautengMpumalangaFree StateNorthern Cape

UNAIDSWHO (MOVE Model)Neighboring countries

SwazilandNamibia

Technical Assistance:

Staff:Dr, Nurse, Aux Nurse, Counsellor, Manager

Assistance:SuppliesProcesses and systemsTraining Mentoring

Time lineAt most 1 month

Start-up Teams:

Survey 2010 in Orange FarmDemand creation studiesOther STI’s

HPVHSV2

MOVE Evaluation

Research:

What have we learnt?What have we learnt?Part 1Part 1

Minimum package of delivery crucialMisunderstanding about MC very challenging

Language issuesMisinformationRisk compensationRisk to women

Excellent opportunity to engage young men about safe sex, HIV in general

VCT / HCT uptake much higher than in general population (VCT 35% HCT 70%)

Individual conversation important to individualise information and discuss 6 week abstinence

What have we learnt?What have we learnt?Part 2Part 2

Information delivery has to be flexible and dynamicTest messaging outcomesObtain feedback from communityReact to research findings

Huge interest from parents about their childrenInformation delivery has to be culturally sensitive

Photos and drawingsWithout political backing and will MC will have

limited impact -> National campaigns

Uncircumcised Partially circumcised Circumcised

Self reported MC statusMen were asked “Are you circumcised?”After the interview a physical examination was done

to which they consented at the beginning of the interview

Physical examination was done by a male nurse45% of men who said they were circumcised had

intact foreskinPossible reasons:

Confusion between MC and InitiationConfusion with words used, vernacularLack of knowledge on what MC is

How does HIV compare in these groups?

HIV (%) and circumcision status

0

5

10

15

20

25

13

‘’Circumcised’’with foreskin

Uncircumcised

PRR=0.93 p=0.73

18.8%20.2%

HIV (%) and circumcision status

14

‘’Circumcised’’with foreskin

Uncircumcised0

5

10

15

20

25

PRR=0.48 p=0.002

18.8% 20.2%

9.5%

‘’Circumcised’’without foreskin

Thus, self reported MC status is a VERY unreliable indicator

Prof Bertran AuvertDr Dino RechProf David LewisProf Adrian PurenScott BillyCynthia NhlapoProf Mohamed HaffejeeGoliath GumedeVeerle Dermaux-MsimangPascale Lissouba

Acknowledgements

Bongiwe Klaas Tsietsi MbusoGaph Phatedi Bongani MazibukuAgenda GumbuDr ShilalukeDr ZuluDr GwalaDr Thabo MashigoDr Sean DoyleDr Josephine DarkoFrans RadebeVenessa Maseko

Dirk [email protected]+27 82 454 6964