Seasonality and male circumcision: an analysis of quarterly PEPFAR-supported voluntary medical male circumcisions for HIV prevention, 2016 ' 2019


BACKGROUND: Since 2007, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has supported voluntary medical male circumcision (VMMC) programs in 15 sub-Saharan African countries. This analysis evaluates the seasonality of VMMCs performed during 2016-2019, and how this seasonality might vary by region in sub-Saharan Africa.
METHODS: PEPFAR monitoring, evaluation, and reporting data were analyzed from 14 countries that had a PEPFAR-supported VMMC program during 2016-2019. We report the calendar-year quarter during which the most VMMCs were performed each year, by country and region. Multilevel generalized linear regression models were used to estimate the effect of quarter on VMMCs performed by country.
RESULTS: The most VMMCs were performed during the same quarter each year in 6 (42.8%) of the 14 countries (Figure 1). Among these 6 countries, all in Southern Africa, there was a statistically significant association (P value of < 0.05) between the increase in VMMCs performed and the corresponding highest performing quarter. Five of the 6 countries performed the most VMMCs during Quarter 3 (July ' September), and one country had the highest performance in Quarter 2 (April ' June). Four countries performed the most VMMCs during the same two quarters each year. Among these 4 countries, 3 are in Southern Africa. Another 4 countries, all in Eastern Africa, had their highest performing quarter vary year to year, and no statistical associations between quarter and VMMCs performed were identified.
CONCLUSIONS: Most PEPFAR-supported VMMCs are performed during April ' June and July ' September, particularly among countries in Southern Africa. Previously reported factors influencing seasonality include perception of improved healing during colder months, seasonal work, school schedules, and traditional circumcision season. It is important to consider seasonality during VMMC program planning to ensure that there is a balance of labor and resources to meet demand.

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