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Richard G. Wamai, PhD
Assistant Professor of Public HealthDepartment of African American studies
Northeastern [email protected]
June 27, 2012
Efficacy of Current Interventions
Sources: Wamai RG. Et al. JIAS. 2011. Grant et al. NEJM 2010; Karim et al, Science 2010; Thigpen et al. 2011
HPTN-START – Strategic Timing of Antiretroviral Therapy
TDF2-Botswana
MC Scientific Evidence is Unequivocal
4 Ecological studies 35 Cross-sectional studies 14 Prospective studies 3 Randomized control trials 100s Reviews, systematic reviews and meta-
analyses
MC Protection rate = 60-80%
Sources: Dickson K, Farley T. 2010; Wamai RG, et al. JIAS. 2011. Morris BJ, Wamai RG. JAIDS. 2012
Sources: Morris BJ, Wamai RG. JAIDS. 2012
MC Acceptability, variable results
Source: Morris BJ, Waskett JH, Banerjee J, Wamai RG., et al. A Snip in Time. BMC Pediatrics 2012
MC trends in the new-borns, US, 1999-2010
SourceS: CDC. MMWR, 2011, Sep 2; 60:1167-8; Source: Smith KD et al. 2010CDC policy
18 US states have eliminated Medicaid funding for MC
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Source: Morris BJ, Waskett JH, Banerjee J, Wamai RG., et al. A Snip in Time. BMC Pediatrics 2012
MC Implementation in 14 SSA Countries, October 2011
Source: Wamai RG, et al. JIAS. 2011
Distance to Goal
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A march through Kisumu helped publicize the launch of the Rapid Results
VMMC Way Forward Health provider training to be tailored to existing health
systems and service structures – public & private (PPPs) Efficiency Models for accelerating MC
Model For optimizing The Volume and efficiency of MC Services (MOVE)- approach (S.Africa)
Task shifting for nurses and clinical officers as per WHO Guidelines (Kenya and Zambia)
RRI – Rapid Results Initiative (Kenya) Instrumentation: Devices that facilitate quicker and safer
adult and infant MC Use of traditional circumcisers after proper training and
provision of services in a culturally appropriate fashion WTA – Conditional economic incentives to spur demand
Source: Wamai RG, et al. JIAS. 2011
Think you are not at risk of
HIV?Think Again, Again
15
Asanteni – Thanks
