Background: VMMC is a proven HIV prevention intervention for men. Nine cases of tetanus infection that resulted into 6 deaths were reported and MoH recommended 2TT doses 28 days apart before circumcision.
We have observed a decline in VMMC uptake which could affect cost per circumcision and the number of infections that would be averted.
Modeling done in Rakai showed that the number of surgeries required preventing one infection over 10 years ranged between 19-58.
We assessed the effect of the 2TT dose policy on VMMC uptake, cost per circumcision, and number of new HIV infections averted over 10 years.
Methods: VMMC service data collected between April and November 2016 from Masaka region was used for this analysis. Between April and June (Period 1) all men received one TT dose and were circumcised on the same day. The 2TT dose policy was fully implemented between August and November 2016 (Period 2) and all men received 2TT doses before circumcision.
We used chi-square test to compare VMMC uptake and cost per circumcision before and after the introduction of the TT policy and estimated the number of new HIV infections that could occur over 10 years.
Results: Of all men who got TT1 in period 1, 99.3% (15,211/15,317) were circumcised compared to 56.2% (9,565/17,017) in period 2 (p< 0.0001).
During period 1 (TT1 only), the total number of surgeries done was 15,211, an average of 5,070 circumcisions per month. In period 2 (2TT doses), 9,565 circumcisions were done, an average of 2,391 per month. The difference in monthly circumcisions between the 2 periods was 2,679 (52.8%) which translates into 10,716 missed circumcisions in 4 months and 32,148 in a year, despite availability of funds.
The operation cost per circumcision in period 2 increased by 55% compared to period 1.
The number of HIV infections that we would fail to avert over ten year''s range from 554 to 1,692.
Conclusions: In Masaka region, the Ugandan TT policy led to a more than 50% reduction in the number of men receiving circumcision, increased the cost per circumcision, and can reduce the number of HIV infections averted.