Facility Characteristics Preferred by Older Men Seeking Medical Male Circumcision Services in Kenya: Qualitative Findings From the ‘tasco’ Study (May 2014-june 2016)

Primary healthcare facilities are central to the implementation of voluntary medical male circumcision (VMMC) as points of access to integrated health services. Factors that explain men’s uptake of VMMC and sexual health services at these facilities and differences across demographic groups remain poorly understood. Using qualitative methodologies, we examined determinants of facility choice for VMMC services among men aged 25 - 39 years who previously underwent VMMC. As part of a randomized controlled trial to assess impact of two demand creation interventions in western Kenya, we conducted 24 focus group discussions (FGD) with 6-10 participants. Six FGDs were conducted for each of the four distinct participant groups; circumcised men, their sex partners, uncircumcised men, and their sex partners. Similarly, six in-depth interviews (IDI) were conducted with participants from each of the four groups for a total of 24. Identified themes were organized as follows: service availability, accessibility, affordability, appropriateness and, acceptability. Facility location, physical layout, organization of patient flow, infrastructure, and service provider skills were the outstanding factors affecting the choice of VMMC service outlets by men aged 25 - 39 years. Men’s preferences were further influenced by individual attitudes, knowledge of VMMC services, and tacit balance between their own recognized health needs versus conformity to social-cultural norms. Understanding the determinants of VMMC facility selection by demographic groups is helpful for developing age-specific approaches to increase VMMC uptake.