AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #331 - The Orange Farm experience: ANRS 12126 and the development of models for optimizing the volume and efficiency of MC services
Authors: Presenting Author: Dr Dirk Taljaard - CHAPS
Additional Authors: Prof. Bertran Auvert, Dr. Dino Rech,
Aim: As part of the ethical obligation to provide a successful intervention to the community in which a trial was performed, the ANRS 12126 project was started in Orange Farm, a semi-urban area just south of Johannesburg where the ANRS 1265 Randomised Controlled Trial on Medical Male Circumcision was performed. The ANRS 12126 (better known as the Orange Farm study) aimed at establishing whether Voluntary Medical Male Circumcision (VMMC) could be rolled-out on a community level, studying possible behavioral compensation, and investigating the effect of mass roll-out on HIV and other STI infection rates. The project however, also rendered the opportunity to do operational research on the issue of roll-out and on the feasibility to do mass circumcisions. The implementation of roll-out followed the WHO/UNAIDS recommendations, which stipulated that any intervention around VMMC had to deliver a comprehensive prevention package. This package included group education, individual risk counseling and voluntary HIV counseling testing.
Method / Issue: Community outreach and information strategies were designed aimed at providing information to the community at large. This information would facilitate the process of men, and even the parents and partners to these men, to make informed decisions about VMMC. Communication, education and counseling materials were developed to fulfill the requirements of a comprehensive prevention package, including Voluntary Counseling and Testing (VCT) and later adapted to HIV Counseling and Testing (HCT). It was immediately evident that conventional methods of a clinical team circumcising one person at a time in a theater was not going to be possible. Developments were made to improve the efficiency of surgery in terms of the time required from professional staff, use of facilities and use of equipment; which in turn greatly effected cost.
Results / Comments: The operational research done in the Orange Farm project, support by WHO, led to establishing what is no known as Models for Optimizing the Volume and Efficiency of MC Services (MOVE). The Orange Farm experience has demonstrated that mass circumcisions are feasible, that the cost could be reasonable and that safety and quality is not sacrificed in the process. The project also demonstrated the effect on Risk Compensation and the potential impact on HIV and STIs such an intervention could have in communities where high levels of uptake was possible.
Discussion: The Orange Farm roll-out have to date circumcised more than 20,000 young men in this community. There have been many challenges and issues surrounding roll-out activities for Voluntary Medical Male Circumcision and a number of papers have been published. This presentation aims give a glimpse of a working roll-out programme and the materials and strategies developed to make roll-out possible. It will likely contribute to the debate on roll-out activities. The Orange Farm project have some unique and interesting data presented here and experiences that could greatly assist other programmes as they start to roll-out Voluntary Medical Male Circumcision.
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