Number of male circumcisions performed according to national standards during the reporting period
Number of male circumcisions performed according to national standards during the reporting period (typically annually). Data should be collected continuously at the facility level and should be aggregated periodically, preferably monthly or quarterly, for use at the local level.
Two guiding documents that inform national standards are the Manual for Male Circumcision under Local Anaesthesia (WHO, UNAIDS and JHPIEGO, 2008) and Guidance for decision-makers on human rights, ethical and legal considerations (UNAIDS, 2008).
Number of males circumcised during the reporting period. Data should be disaggregated by age and HIV status, which includes where the male was tested. For example:
- Tested at facility – positive result
- Tested at facility – negative result
- Tested at facility – indeterminate result
- Tested elsewhere – positive result, verification provided: yes or no
- Tested elsewhere – negative result, verification provided: yes or no
Data could also be disaggregated by location, type of facility (e.g. urban vs. rural, public, private, non-governmental, community-based), and cadre of providers (to determine the results of task-shifting and to help determine resource allocation).
Health facility records
The total number of male circumcisions carried out indicates either a change in the supply of services or change in demand. Comparing the results against previous values shows where male circumcision services have been newly instituted or where male circumcision volume has changed.
When numbers of male circumcisions are disaggregated by HIV status and age, it will be possible to adjust modeling inputs used in models to determine the impact of male circumcision programs on HIV incidence and, if a country has prioritized services to or set targets for particular age groups, determine the success of those priorities. Some programs will work closely with voluntary counseling and testing services to provide HIV testing. A patient desiring male circumcision may have been recently tested, in which event an on-site HIV test may be unnecessary. In these cases, a written ‘verified result’ may be requested at the facility to verify HIV status. There is no specific length of time before male circumcision that the test should have been done, but within three months is suggested (the purpose of testing is not to identify every man who might be infected but to provide HIV testing to men seeking health care and to identify HIV-positive men who, if they choose to be circumcised, are likely to be at higher risk of surgical complications, i.e. men who are chronically infected and with low CD4 counts).
This indicator has also been added under a new Prevention sub-area on male circumcision in the PEPFAR Next Generation Indicators Reference Guide (2009).
This indicator only assesses the number of male circumcision procedures recorded in health facilities (versus in non-formal home or custom settings), which should be performed according to national standards. However, unless the evaluator is observing the procedures to assess compliance with national standards, the standard of care can only be assumed.
male circumcision, quality, HIV/AIDS
WHO & UNAIDS. A guide to indicators for male circumcision programmes in the formal health care system. 2009. http://www.who.int/hiv/pub/malecircumcision/hiv_mc_me.pdf
PEPFAR, 2009, The President’s Emergency Plan for AIDS Relief: Next Generation Indicators Reference Guide, Washington, DC: USAID/PEPFAR. http://pdf.usaid.gov/pdf_docs/Pcaac330.pdf