The Bophelo Pele project (ANRS 12126)

in Orange Farm (South Africa)

Bertran Auvert INSERM CESP U1018University of Versailles,

FranceXIII International AIDS Conference Vienna, Austria 18-23 July 2010

Oral Poster presentation

Bophelo Pele project (ANRS 12126)

• Phase 4 study implemented in 2008 in Orange Farm, South Africa (HIV= 15.2% and male circumcision~15%)

• Provision of medicalized adult male circumcision (AMC) to all male residents aged 15 and older

• Objectives Establish a generalizable model for

providing comprehensive, accessible and acceptable medicalized AMC services

Investigate the feasibility AMC roll-out according to UNAIDS/WHO international recommendations and operational guidelines

Circumcision center

Logo

Communication Radio Information sessions for andCommunity Engagement Household visits Distribution of brochures

Bophelo Pele project: Activities

Recruitment Information visits Counseling for and VCT

AMC Surgery (OMS) Disposable surgical kits Local anesthesia 3 teams of 1 medical circumcisers and 5 nurses

‘Task-sharing’

Bophelo Pele project: Findings• Consultations, discussions, CAB meetings, qualitative studies

Project well accepted by the community and receiving good support

• Satisfaction survey in 2009 (N=1,158)

Quality of services judged very good or good by over 92% of participants

• Audits, external and internal quality control, GCP audits

Provision of high quality services by international standards

• Up to 150 AMCs can be performed per day, for an average circumciser time of 7.30 mins, a total procedure time of 20 mins and a cost of US$38 per AMC

• As of December 2009, 14,011 AMCs have been performed through the project (1.8% adverse events, no death nor permanent injuries)

• AMC uptake in the community: 39.1%

Bophelo Pele project: Conclusions

• A quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines

• Along with similar ongoing interventions in the region (Kenya, Uganda) the project shows that AMC scale-up is a promising prevention method to fight the HIV epidemic in targeted communities of Southern and Eastern Africa

• Next step – Assess the impact of AMC intervention on

• Knowledge, attitudes and practice regarding AMC • Sexual behavior and condom use• Spread of HIV and other STIs at the population level

Acknowledgements

Orange Farm population (South Africa)Bophelo Project team (South Africa)ANRS (France)Progressus (South Africa)SFH (South Africa)NICD – NHLS (South Africa)University of Versailles (France)INSERM (France)