Background: The Uganda Population-Based HIV Impact Assessment 2017 estimated the unmet need for voluntary medical male circumcision (VMMC) at 20% (4,405,741) and of these 2.2% (97,400) were in Eastern Uganda. USAID-funded Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E), led by IntraHealth International, implemented multiple approaches for demand creation to infiltrate and mobilize both traditionally and non-traditionally male circumcising communities of Eastern Uganda for VMMC. The campaign aimed to circumcise 34,313 males based on PEPFAR targets for October 2017-September 2018.
Methods: USAID RHITES-E employed four innovative community-based participatory approaches targeting boys and men aged 15 to 49 for VMMC with special focus on the 15-29 PEPFAR age pivot. Approach 1 engaged 72 female village health teams over nine months to mobilize and educate school-aged boys on the importance of circumcision beyond reducing HIV infection such as hygiene and averting cervical cancer for their female partners. Approach 2 targeted the school holidays in April, August, and December to circumcise school-aged boys who reported fears related to wound healing if circumcised during the school time. Approach 3 engaged five religious leaders over three months to educate communities (especially those traditionally circumcising) on safe clinical services rather than traditional methods. Approach 4 used mobilization through radio, peers, and male village health workers conducting home-to-home visits.
Results: 37,780 boys and men aged 15-49 were circumcised in 14 months (October 2017 to December 2018) and of these, 54% (20,401) were in the PEPFAR VMMC age-pivot of 15-29 years. Of the total, the contribution per approach was 29%, 26%, 19%, and 26%, respectively.
Conclusions: Tailoring VMMC demand-creation to specifically target different ages, align services with the school holidays to give ample wound healing time, and emphasize non-HIV prevention benefits, such as improved hygiene proved to be effective approaches for meeting the target. Promoting VMMC among women appeared to have considerable influence over menĀ“s decision to get circumcised in traditionally non-circumcising communities while the influence of religious leaders was highest among traditionally circumcising communities. Multiple demand creation approaches involving both male and female community mobilizers were most effective in reaching the 15-29 age group.

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