Application of an HIV Prevention Cascade to Identify Gaps in Increasing Coverage of Voluntary Medical Male Circumcision Services in 42 Rural Zambian Communities

  • Bernadette HensenEmail author
  • Elizabeth Fearon
  • Ab Schaap
  • James J. Lewis
  • Helen A. Weiss
  • Margaret Tembo
  • Namwinga Chintu
  • Helen Ayles
  • James R. Hargreaves
Original Paper


Increased coverage of voluntary medical male circumcision (VMMC) is needed in countries with high HIV prevalence. We applied an HIV-prevention cascade to identify gaps in male circumcision coverage in Zambia. We used survey data collected in 2013 and 2014/15 to describe circumcision coverage at each time-point, and prevalence of variables related to demand for and supply of VMMC. We explored whether circumcision coverage in 2014/15 was associated with demand and supply among uncircumcised men in 2013. Results show that circumcision coverage was 11.5% in 2013 and 18.0% in 2014/15. Levels of having heard of circumcision and agreeing with prevention benefits was similar at both time-points (79.8% vs 83.2%, and 49.7% vs 50.7%, respectively). In 2013, 39.3% of men perceived services to be available compared to 54.7% in 2014/15. Levels of having heard of circumcision in 2013 was correlated with and higher perceived service availability associated with coverage in 2014/15. VMMC coverage was low in these study sites. Knowledge of prevention tools and of service availability are necessary to increase coverage but alone are insufficient.


Voluntary medical male circumcision HIV prevention cascade Zambia Africa HIV 



The authors would like to express their gratitude to the men who participated in the surveys, and the BHOMA community survey team leaders and research assistants.


The BHOMA trial was part of the Africa Health Initiative launched by the Doris Duke Charitable Foundation (Grant# 2009060). Funding was provided by Economic and Social Research Council (Grant No. ES/J500021/1).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinical Research Department, Infectious and Tropical DiseasesThe London School of Hygiene and Tropical MedicineLondonUK
  2. 2.Public Health, Environments and Society, Public Health and PolicyThe London School of Hygiene and Tropical MedicineLondonUK
  3. 3.Infectious Disease Epidemiology, Epidemiology and Population HealthThe London School of Hygiene and Tropical MedicineLondonUK
  4. 4.ZambartUniversity of ZambiaLusakaZambia
  5. 5.Society for Family HealthLusakaZambia

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