Background: Voluntary Medical Male Circumcision (VMMC) reduces the chances of HIV infection from females to males by approximately 60%. Lesotho adopted VMMC as a priority HIV prevention strategy in 2012. Focusing on outcome of care, programs are advised to implement mechanisms in which health care services will be systematically monitored and evaluated for access, quality and continuity of care. We reviewed the outcome of care through quality aspects of the program including by examining follow-up and adverse event rates and trends.
Methods: We conducted a retrospective review of the VMMC client database from September 2012 to September 2016. Reported follow-up and adverse events were categorized and reviewed by fiscal years and the overall trend summarized in a graph.
Results: A total of 129,982 clients were circumcised during the review period. Of these, 92,041 clients (75.8%) returned for at least one follow-up visit. The overall follow-up rate dropped at the second year of the program but improved gradually over time to 2016. In addition, the AE rates dropped gradually from 1.9% in FY12 to 0.2% in FY 16. In general, there was a remarkable improvement of the safety parameters over the review period.

AE Rates VMMC Lesotho 5 Years
[AE Rates VMMC Lesotho 5 Years]

Conclusions: Our review revealed significant improvement on follow-up rates and a drop in adverse event rates in over 5 years of program implementation. One of the explanations for these observations could be the regular refresher trainings to providers and counselors so that safety and quality of service become priorities. Mobilizers and community volunteers are also trained in all aspects of VMMC program including quality of care. Both clinical and demand creation teams need to take into account clients'' satisfaction and care. Improved quality and perceived safety will increase demand for services from the community.

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