Background: Targeting voluntary medical male circumcision (VMMC) to men aged 15-29 years helps reduce HIV incidence. In 2016, the US President''s Emergency Plan for AIDS Relief (PEPFAR) technical guidance recommended that VMMC programs in all countries prioritize men in this age group. A review of 2016 performance data indicated that most circumcision clients in Lilongwe, Malawi, were boys younger than 15 years. We evaluated the program''s efforts to target men aged 15-29 years.
Methods: VMMC aggregate program data are collected monthly through partner monitoring and evaluation system and reported quarterly to PEPFAR. We analyzed program data from 2016 to 2018 to examine trends in clientele age and total number of VMMCs performed. Data were grouped by US government fiscal year (October 1-September 30) and disaggregated by quarter and age. Descriptive analyses were performed to evaluate VMMC program performance.
Results: Of all clients who underwent circumcision in Lilongwe in 2016, 44% were aged 15-29 years. In 2017 and 2018, 71% and 82% of circumcisions, respectively, were among men aged 15-29 years, with an overall increase of 86% from 2016. Performance improvements in 2017 and 2018 are attributed to implementation of the following demand creation strategies: training satisfied VMMC clients within the priority age group to be community mobilizers; community mapping of male congregate areas (e.g., markets or bawo games); extending service hours to accommodate work hours and clients with privacy concerns; partnering with community leaders and key influencers to act as VMMC champions; and enhancing referrals from other health service delivery points.
Conclusions: Implementing age-targeted demand creation activities effectively improves VMMC service uptake among this priority age group. Further refinements include scaling provider referrals to all district sites and expanding community mobilization activities all year to minimize seasonal demand.

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