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Zimbabwe turns to reusable circumcision kits
2 hrs ago |
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Zimbabwe is exploring the adoption of reusable circumcision kits to sustain its Voluntary Medical Male Circumcision (VMMC) programme amid shrinking international funding and the withdrawal of major donors.
VMMC has been one of the country's most effective HIV prevention tools since its launch in 2009, credited with helping reduce new infections nationwide. At its peak in 2012, Zimbabwe recorded over 1.1 million circumcisions, nearing its goal of achieving 80% coverage among adult males and newborns. To maintain these levels, the country had targeted at least 150,000 circumcisions annually.
However, the future of the programme has come under threat after the U.S. government, through the President's Emergency Plan for AIDS Relief (PEPFAR), halted funding for circumcision and condom programming outside its new global priorities. PEPFAR, the Global Fund, and the Bill & Melinda Gates Foundation had previously financed most VMMC activities through implementing partners such as the ZAZIC Consortium and Population Services for Health (PSH).
Although PEPFAR has rolled out a US$65 million Bridge Plan to temporarily sustain Zimbabwe's HIV programmes, VMMC and condom distribution were excluded.
With donor funding ending, the Ministry of Health and Child Care (MoHCC) has assumed full responsibility for the VMMC programme, signaling a shift toward local ownership and sustainability.
"VMMC is one of the programmes most affected by the cuts in funding. At 0% funding, we are looking at using reusable kits and focusing mainly on efficiency-based delivery of VMMC," said Dr. Tsitsi Apollo, deputy director in the MoHCC's AIDS and TB Unit.
She added that, at reduced funding levels, the ministry will scale down outreach activities and combine reusable and limited disposable kits to sustain operations. "At 25% funding, we can combine reusable and limited disposable kits with targeted campaigns. With 50% funding, we would have more flexibility to expand operations. Condom programming has also been affected," Dr. Apollo said.
The proposal to introduce reusable circumcision kits has sparked safety concerns among public health stakeholders. Experts warn that improper sterilization could lead to infections or cross-contamination if strict protocols are not observed.
Reusable kits must be cleaned with soapy water and brushes, avoiding corrosive disinfectants such as chlorine, and regularly inspected to remove damaged instruments.
Dr. Apollo assured the public that safety remains a top priority, noting that reusable kits are already in use in several countries under World Health Organization (WHO) guidelines. "The Ministry of Health has infection control policies and standards to ensure minimal or no risk of transmission. Safety is guaranteed. This is not a practice unique to Zimbabwe; it is in line with WHO recommendations," she said.
WHO guidance recognises two main types of circumcision kits - single-use disposable and reusable surgical instruments - both of which can be safely implemented under strict sterilization protocols. Countries such as Kenya, Tanzania, Eswatini, and South Africa have used mixed models depending on cost and logistics.
Despite its proven effectiveness - reducing female-to-male HIV transmission risk by up to 60% - Zimbabwe's VMMC uptake has dropped sharply.
Between January and March 2024, the programme targeted 235,366 circumcisions but achieved only 41,160, according to MoHCC data. By December 2023, no province had reached the 80% coverage goal; the highest rates were in Lupane and Tsholotsho (61%), while Kariba and Binga recorded just 17% and 19%, respectively.
COMPASS Zimbabwe Country Director, Munyaradzi Chimwara, said the low uptake suggests that resources could be redirected to other HIV prevention tools such as PrEP.
"VMMC uptake has been very low when measured in U.S. dollar terms compared to condoms and PrEP. It does not make a strong investment case," said Chimwara. "Also, VMMC, like condoms, is a male-controlled prevention measure, which limits women's protection. PrEP provides an opportunity for both genders to take control of their sexual health."
As Zimbabwe transitions toward domestically financed HIV prevention, experts say the country must balance cost efficiency, public safety, and programme sustainability.
Health analysts agree that reusable kits, if implemented under strict WHO-compliant sterilization and infection control protocols, could offer a practical solution to sustain VMMC in the face of dwindling donor support. However, they warn that maintaining public confidence and high clinical standards will be crucial to keeping the programme both effective and trusted.
VMMC has been one of the country's most effective HIV prevention tools since its launch in 2009, credited with helping reduce new infections nationwide. At its peak in 2012, Zimbabwe recorded over 1.1 million circumcisions, nearing its goal of achieving 80% coverage among adult males and newborns. To maintain these levels, the country had targeted at least 150,000 circumcisions annually.
However, the future of the programme has come under threat after the U.S. government, through the President's Emergency Plan for AIDS Relief (PEPFAR), halted funding for circumcision and condom programming outside its new global priorities. PEPFAR, the Global Fund, and the Bill & Melinda Gates Foundation had previously financed most VMMC activities through implementing partners such as the ZAZIC Consortium and Population Services for Health (PSH).
Although PEPFAR has rolled out a US$65 million Bridge Plan to temporarily sustain Zimbabwe's HIV programmes, VMMC and condom distribution were excluded.
With donor funding ending, the Ministry of Health and Child Care (MoHCC) has assumed full responsibility for the VMMC programme, signaling a shift toward local ownership and sustainability.
"VMMC is one of the programmes most affected by the cuts in funding. At 0% funding, we are looking at using reusable kits and focusing mainly on efficiency-based delivery of VMMC," said Dr. Tsitsi Apollo, deputy director in the MoHCC's AIDS and TB Unit.
She added that, at reduced funding levels, the ministry will scale down outreach activities and combine reusable and limited disposable kits to sustain operations. "At 25% funding, we can combine reusable and limited disposable kits with targeted campaigns. With 50% funding, we would have more flexibility to expand operations. Condom programming has also been affected," Dr. Apollo said.
The proposal to introduce reusable circumcision kits has sparked safety concerns among public health stakeholders. Experts warn that improper sterilization could lead to infections or cross-contamination if strict protocols are not observed.
Reusable kits must be cleaned with soapy water and brushes, avoiding corrosive disinfectants such as chlorine, and regularly inspected to remove damaged instruments.
Dr. Apollo assured the public that safety remains a top priority, noting that reusable kits are already in use in several countries under World Health Organization (WHO) guidelines. "The Ministry of Health has infection control policies and standards to ensure minimal or no risk of transmission. Safety is guaranteed. This is not a practice unique to Zimbabwe; it is in line with WHO recommendations," she said.
WHO guidance recognises two main types of circumcision kits - single-use disposable and reusable surgical instruments - both of which can be safely implemented under strict sterilization protocols. Countries such as Kenya, Tanzania, Eswatini, and South Africa have used mixed models depending on cost and logistics.
Despite its proven effectiveness - reducing female-to-male HIV transmission risk by up to 60% - Zimbabwe's VMMC uptake has dropped sharply.
Between January and March 2024, the programme targeted 235,366 circumcisions but achieved only 41,160, according to MoHCC data. By December 2023, no province had reached the 80% coverage goal; the highest rates were in Lupane and Tsholotsho (61%), while Kariba and Binga recorded just 17% and 19%, respectively.
COMPASS Zimbabwe Country Director, Munyaradzi Chimwara, said the low uptake suggests that resources could be redirected to other HIV prevention tools such as PrEP.
"VMMC uptake has been very low when measured in U.S. dollar terms compared to condoms and PrEP. It does not make a strong investment case," said Chimwara. "Also, VMMC, like condoms, is a male-controlled prevention measure, which limits women's protection. PrEP provides an opportunity for both genders to take control of their sexual health."
As Zimbabwe transitions toward domestically financed HIV prevention, experts say the country must balance cost efficiency, public safety, and programme sustainability.
Health analysts agree that reusable kits, if implemented under strict WHO-compliant sterilization and infection control protocols, could offer a practical solution to sustain VMMC in the face of dwindling donor support. However, they warn that maintaining public confidence and high clinical standards will be crucial to keeping the programme both effective and trusted.
Source - HealthTimes
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