Clinical Resources

During the controlled clinical trials demonstrating that circumcision decreased female-to-male transmission of HIV (see malecircumcision.org), researchers pioneered several methods to increase efficiency and the number of procedures per surgeon, including choosing an efficient MC technique (forceps-guided), designing efficient patient flow through the facility, and using pre-packaged kits. This model, named Model for Optimizing Volume and Efficiency (MOVE) was implemented during the Accelerated Saturation Initiative (ASI) for male circumcision (MC) in Swaziland during the 2011 time period. As mentioned in the overview, recommendations for clinical scale back were implemented as of January 1, 2012 with a reduced clinical team. Before the scale back, the Swaziland MC Task Force, defined the MOVE team complement for Swaziland to include:Msandi Kababa, King Mswati III’s praiser/poet and MC ambassador for Soka Uncobe undergoing male circumcision in the theatre.

  • 1 doctor
  • 7 nurses
  • 3 MC Counselors
  • 1 cleaner/hygienist
  • 1 theater runner
  • 1 site manager
  • 1 receptionist
  • 1 data capturer
  • 1 security guard
  • 1 expert client

This team is designed to conduct 40-plus MCs per day. Skilled human resources (doctors, nurses, and HTC/MC counselors) underwent competency-based training and/or skill validation prior to service delivery. Support positions, including the non-nurse runner, cleaner/hygienist, site managers, receptionists, data capturers, etc., received targeted, position-specific orientations prior to engagement in Soka Uncobe.

Close adherence to nationally established standards for quality assurance were maintained throughout Soka Uncobe. All MC service delivery sites underwent a baseline quality assurance (QA) assessment. The Quality Assurance team was composed of representatives from the Ministry of Health, Swaziland National AIDS Program, the Soka Uncobe Clinical Director and a Quality Assurance Technical Assistant. The team conducted assessments at the opening of each site. Following the initial assessment, the team conducted routine support and supervisory visits to each site to identify root causes for any gaps identified in previous assessments and assisting the sites in identifying and implementing solutions. In addition the QA team organized external service accountability reviews of the sites to ensure that sites maintained international standards.

Data collection is also an important component of clinical services to ensure effective monitoring and evaluation. The speed at which information is collected, electronic data are made available and analyzed, and results are reported for program and political action is unique to Soka Uncobe. Data collection at service delivery sites is standardized to facilitate the required speed for data analysis and reporting, and critical Soka Uncobe M&E data will be available in real-time. JSI-hired data collectors were stationed at each of the clinical sites to input data collected using the MC and HIV Testing and Counseling intake forms (available here).

 

Resources