Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1(Dec09) and developed countries. The manual and materials were reviewed by actual and potential providers of male circumcision services representing a range of health care and cultural settings where demand for male circumcision services is high. This manual is one of several documents and guidelines developed by WHO, UNAIDS and partners to assist countries develop and implement programmes for safe medical male circumcision for HIV prevention within the context of their existing HIV prevention activities, and sexual and reproductive health programmes. All documents can be downloaded from the Clearinghouse on Male Circumcision for HIV Prevention (www.malecircumcision.org), a web site created to share technical and policy guidance, knowledge, tools and experience relevant to implementing male circumcision programmes. The most relevant documents include: New data on male circumcision and HIV prevention: Policy and programme implications − provides guidance to policy makers and programme managers on issues that need to be considered and addressed when planning for programme scale-up. Operational guidance for scaling up male circumcision services for HIV prevention. This document provides operational and programmatic guidance to decision-makers, programme managers and technical support agencies on scaling up programmes in the public and private sectors. Male Circumcision Quality Assurance: A Guide to Enhancing the Safety and Quality of Services − outlines the roles and responsibilities of national and district programme managers for implementing safe quality male circumcision services and provides guidance for the planning of a national quality assurance programme. It defines ten quality standards against which the quality of services can be measured and used as part of a continuous process of service improvement. The guide is supplemented by the Male circumcision services quality assessment toolkit which is used by facility managers and providers to assess their own performance. It can be used by national and district managers to conduct external assessments of facilities. The toolkit includes a scoring tool, into which users can enter assessment findings and monitor progress towards meeting the standards. Considerations for implementing models for optimizing the volume and efficiency of male circumcision services for HIV prevention. This document provides guidance to help programmes improve the efficiency of clinical and surgical activities so that they can strengthen their capacity to meet demand for male circumcision services. It addresses clinical techniques, staffing, facility space, client scheduling and flow, commodities management, cost efficiencies, and quality assurance. It also includes detailed model lists of equipment and supplies required to support a male circumcision programme. A guide to indicators for male circumcision programmes in the formal health care system lists indicators that programmes can use to monitor and evaluate progress towards their programme objectives. Adaptable to different country situations, the guide includes indicators of demand for, and supply of, male circumcision services, as well as measures to assess secondary effects of the programme, such as changes in sexual behaviours at the individual and community levels. Page viii
Male circumcision under local anaesthesia Version 3.1(Dec09) ACKNOWLEDGEMENTS This manual is based on the work of a large group of clinical and public health experts who participated in technical consultations and reviews. Particular thanks are due to the following: - Tim Hargreave and Emmanuel Otolorin who wrote and edited the draft manual; - the Orange Farm, Kisumu and Rakai study teams, who generously shared slides, videos and training materials; - Robert Bailey, Palesa Mohaleroe, Emmanuel Otolorin and Stephen Watya for photographic illustrations; - Oheneba Owusu-Danso and Kwabena Danso for photographs and a description of the Gomco clamp method, from which the illustrations were made; - Bill Mansen and John Orr for review of Chapter 7; - Micheline Diepart, Gerald Dziekan and Selma Khamassi for review of Chapter 8; - Gillian Kidd, Department of Medical Illustration, University of Edinburgh, Scotland who prepared the illustrations of the surgical methods; - Melanie Bacon, Robert Bailey, AS Chawla, Han-Sun Chiang, Kelly Curran, Adam Groeneveld, John Krieger, Jasper Nduasinde, Redouane Rabii, and Stephen Watya who provided detailed written comments on the manual; - Joanne Ashton, Joint Commission International; - Bertran Auvert, Melanie Bacon, Kasonde Bowa, Dy Bun Chhem, Kelly Curran, Adam Groeneveld, Tim Hargreave, Chris Heyns, Martin Kaluwaji, Sifuni Koshuma, Chiapo Lesetedi, Palesa Mohaleroe, Samuel Mutamba, Jasper Nduasinde, John Opeya Oloo, George Shawi Shilaluke, Ajit Sinha, B.S. Toma, Stephen Watya and Charles Wiysonge who participated in a technical review of the draft manual in Montreux, Switzerland, in April 2006; and - Khalil Abu-Dalu, Adam Abzak, Yona Amitai, Zahavi Cohen, Cyril Fine, Esther Galili, Benjamin Gesundheit, Debby Gedal-Beer, Eitan Gross, Mordechai Halperin, Pinhas Livne, Yoram Mor, Neil Perlman, Hanni Rosenberg, Inon Schenker, Francis Serour, Eli Simhi and Moshe Westreich, for detailed review and comments during a technical meeting in Jerusalem, Israel, in December 2006, facilitated by the Jerusalem AIDS Project. The technical content of the manual has been reviewed by representatives of the Pan- African Urological Surgeon’s Association (PAUSA), the Korean Andrology Society, the Taiwan Andrology Society, and the Israeli Association of Paediatric Surgery. The development of the manual was coordinated by Tim Farley and Manjula Lusti- Narasimhan (WHO Department of Reproductive Health and Research), Isabelle de Zoysa (WHO Family and Community Health Cluster), Kim Dickson and George Schmid (WHO Department of HIV and AIDS) Meena Cherian (WHO Department of Essential Health Technologies), and Cate Hankins (UNAIDS). Final technical editing and layout were undertaken by Pat Butler and …, respectively. Page ix
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Manual for Male Circumcision under Local Anaesthesia

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