Kenya has the third largest population of people living with HIV in sub-Saharan Africa, and the highest national HIV prevalence of any country outside of southern Africa and Nigeria. The National HIV and AIDS Estimates Working Group estimated the HIV prevalence rate among people in Kenya aged 15-49 to be 6.0% in 2013. Although modelling results show a decline in HIV prevalence among the adult population in Kenya from the late 1990s to 2008, the prevalence has since stabilized.
The link between male circumcision (MC) and reduced risk for HIV acquisition in men was first observed in Kenya in the 1980s. In November 2008, the Kenyan Ministry of Health (MOH) launched a National Voluntary Male Medical Circumcision (VMMC) programme, with a target of circumcising 860,000 men aged 15-49 years by the end of 2013. VMMC service provision scale-up began towards the end of September 2008, through financial support from the United States government’s President’s Emergency Program for AIDS Relief (PEPFAR) and the Bill & Melinda Gates Foundation (BMGF).
Since the start of the VMMC programme, it has prioritized the training of health service providers, upgrading government health facilities to provide safe VMMC services, creating demand for these services in partnership with NGOs, and pilot- testing new male circumcision technologies. Over 3,000 service providers, including surgeons, surgical assistants, counsellors and infection prevention officers have been trained. At least 575 VMMC service provision facilities (integrated and outreach) have been upgraded in Nyanza, Western, Rift Valley, Nairobi and other regions, thereby greatly enhancing access to safe and effective VMMC services. By the end of 2013, 792,931 “new” medical circumcisions had been performed, increasing the national coverage from 85% to 92%. The coverage in Nyanza increased from 48% to 66%, the only region to attain the targeted number of circumcisions during phase I of the VMMC programme.
Based on the experience and success of Phase 1 of the VMMC programme, in 2014, Kenya launched the second phase, which prioritized sustainability and maintenance of the results achieved in the first phase. Kenya developed its second national VMMC strategic and operational plan for the period 2014/15 – 2018/19. The strategy was developed pursuant to the objectives of the Kenya Health Policy, 2012 – 2030; the Kenya AIDS Framework, 2014 – 2019; and the National Guidance on Male Circumcision in Kenya, 2008. In this phase, Kenya has adopted a mixed strategy to sustain its achievements by focusing on both adolescent and early infant circumcision. Therefore, in addition to catching up on the remaining adultmale circumcisions, Kenya plans to: 1) expand adolescent circumcisions by reducing the age of circumcision to 10 years rather than 14 years; 2) introduce early infant male circumcision (EIMC); and 3) increase the focus on programme safety.
The main goal of the formation of a VMMC Technical Support Unit( TSU) is to assist the Government of Kenya in implementing the second phase of its Voluntary Medical Male Circumcision programme, which aims to sustain the gains achieved in the first phase of the programme through improved governance, capacity strengthening and resource mobilization. To effect this, technical assistance for VMMC programming was incorporated into the existing Technical Support Unit (TSU) within the National AIDS and STI Control Programme (NASCOP), Ministry of Health, Government of Kenya. The TSU is managed by a team established by the University of Manitoba, with Foundation support.