Mobile Male Circumcision in Tanzania
In a meeting with Redempta Mbatia and Abubakar Mwinyi at ICAP Tanzania today, I learned about their recent implementation of a mobile male circumcision (MC) program on islands in Lake Victoria (Kagera Region).
The MC intervention was a demonstration project requested by the Tanzanian Ministry of Health and Social Welfare to incorporate MC and prevention activities in remote places. ICAP was working on the mainland in Kagera region, but CDC and USAID preferred they work on the islands, where HIV prevalence was much higher (3 or 4 times higher than on the mainland — estimated at near 20% says Dr. Mbatia). They worked in a truly underserved area: there were 2 dispensaries serving 20 islands (with 2 staff — neither were clinicians or nurses) — Dr. Mbatia said there was almost no health infrastructure — and very few HIV-positive islanders would travel to the mainland for treatment (many were lost to follow-up).
The process was extensive. First, they got buy-in from regional and local authorities, then they introduced the intervention to the population more broadly. At the same time as their sensitization campaigns, they mobilized the team and infrastructure to carry out the intervention. Sensitization campaigns incorporated influential locals, including government, local government, and religious leaders. Abubakar was invited by local religious leaders to speak at a gathering the religious leaders called to discuss the MC project. As a result of that meeting, 300 men signed up for the procedure. Both also said that there was a priest in Kagera who had a strong impact in their outreach. The sensitization campaign relied on other, more typical outreach activities, such as local drama groups and airtime on the local radio station for a Q&A about MC.
Following the sensitization campaign, there were a great number of logistical hurdles. In addition to being spread across 20 islands, the target population was largely mobile (most were fishermen). I asked how they managed to get the word out to people about where they were going to be working and Abu said no — we found out where the people were going to be on a certain day and we went there. Redempta then remarked that the difficulty was that the men were at those places because they were fishing, so it was hard to get them to leave their jobs for a day. Abu said they would work with the “fish lords” (perhaps equivalent to estate owners vis-a-vis day labor farmers) to coordinate schedules about who would work some days and who would get circumcised on those days. Abu organized free transportation for anyone who was signed up for MC. This meant he arranged boat rides for participants. Eventually, ICAP convinced a donor to procure a boat (because the small, unreliable boats available just weren’t cutting it). The boat is owned by the local district health office, not ICAP. Redempta emphasized the importance of working with the District Health Management Team, saying that their DHMT sees the intervention now as their own project, and they are the ones implementing it.
Following the success of the mobile MC campaign, the intervention has now expanded to include comprehensive care (e.g., ART, PMTCT, STIs, VCT).