scholarly journals Outcomes of voluntary medical male circumcision performed by medical doctors and non-doctor health workers in central Uganda

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Hope Kibansha Matumaini ◽  
Anthony Batte ◽  
Kennedy Otwombe ◽  
Emily Lebotsa ◽  
Sam Luboga
Keyword(s):  
Adverse Events ◽  
Male Circumcision ◽  
Health Workers ◽  
Scale Up ◽  
Task Shifting ◽  
Urethral Injury ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Post Surgery ◽  
Significant Difference

Abstract Background Voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission. Task shifting of VMMCs to non-doctor health workers is recommended to enhance scale-up of VMMC programs. This study evaluated outcomes of circumcision conducted by doctors compared to non-doctors in central Uganda. Methods In this prospective observational study, we observed and followed 274 males at 3 health facilities in Kampala, Uganda. Each participant was observed during the circumcision procedure, monitored for 2 h post-surgery and assessed at 24 h, 3 days and after one week for adverse events. Results The median age of the circumcised men was 24.00(IQR, 20.00–28.00) years. Of the VMMCs, 19.3% (53/274) were carried out by doctors while 80.7% (221/274) by non-doctors. Following VMMC, 5.47% (15/274) men experienced adverse events and proportions of adverse events by cadre were similar; doctors (5.66% [3/53]) and non-doctor health workers (5.43% [12/221]), p = 0.99. Seven participants had pus discharge (all had been operated by non-doctors), 2 participants had bleeding at 2 h (one by doctor and one by non-doctor), and 4 participants had excessive skin removal (2 by doctors vs 2 by non-doctors). There was no reported urethral injury or glans amputation. Conclusion Our study found no statistically significant difference in the incidence of adverse events among VMMCs conducted by doctors compared to non-doctor health workers. Our study showed no incidence of serious adverse events such as death, urethral injury or glans amputation following VMMCs. Our results add to the existing literature to guide task shifting in the context of VMMCs.

scholarly journals Outcomes of male circumcision performed by medical doctors and non–doctor health workers in central Uganda

2020 ◽  
Author(s):  
Hope Kibansha Matumaini ◽  
Anthony Batte ◽  
Kennedy Otwombe ◽  
Emily Lebotsa ◽  
Sam Luboga
Keyword(s):  
Adverse Events ◽  
Male Circumcision ◽  
Health Workers ◽  
Medical Doctor ◽  
Urethral Injury ◽  
Medical Doctors ◽  
Post Surgery ◽  
Skin Removal ◽  
Event Rates ◽  
Excessive Skin

Abstract Objective: Task shifting for male circumcision is still a challenge. The aim of this study was to evaluate the outcomes of circumcision conducted by doctors compared to non-doctors in Kampala, UgandaResults: In this prospective cohort study, we observed and followed 274 males at 3 health facilities in Kampala, Uganda. Each participant was observed during the circumcision procedure, monitored for 2 hours post-surgery and assessed at 24hours, 3 days and after one week for adverse events. The mean age of the circumcised men was 24.82 (6.36) years. Of the circumcisions, 19.3% (53/274) were carried out by doctors while 80.7% (221/274) by non-doctor health workers. About 5.47% (15/274) experienced adverse events and the proportions by cadre were similar; medical doctors (5.66% [3/53]) and non-doctor health workers (5.43% [12/221]), p=0.99. Seven patients had evidence of pus discharge (all had been operated by non-doctors), only 2 patients had bleeding at 2 hours (one by medical doctor and one by non-doctor), 4 patients had evidence of excessive skin removal (2 by medical doctor vs 2 by non-doctors). There was no reported urethral injury or glans amputation. These results indicate that non-doctor health workers can offer circumcision services safely with low adverse event rates.

scholarly journals Description of adverse events among adult men following voluntary medical male circumcision: Findings from a circumcision programme in two provinces of South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0253960
Author(s):  
Evans Muchiri ◽  
Salome Charalambous ◽  
Sibuse Ginindza ◽  
Mpho Maraisane ◽  
Tintswalo Maringa ◽  
...  
Keyword(s):  
South Africa ◽  
Adverse Events ◽  
Male Circumcision ◽  
Surgical Procedure ◽  
Voluntary Medical Male Circumcision ◽  
Excessive Bleeding ◽  
Medical Male Circumcision ◽  
Adult Men ◽  
Post Surgery

Background Clinical trials showed strong evidence that voluntary medical male circumcision (VMMC) reduces the acquisition of HIV among heterosexual men by up to 60%. However, VMMC uptake in East and Southern Africa remains suboptimal, with safety concerns identified as a barrier to uptake. We investigated the occurrence and severity of adverse events (AEs) in a routine VMMC programme implemented in Gauteng and North West provinces of South Africa. Methods We describe the frequency and characteristics of AEs using routinely collected data from a VMMC programme implemented between 01 May 2013 and 31 December 2014. The surgical procedure was provided at fixed clinics and mobile units in three districts. Adult men undertaking the procedure were referred for follow-up appointments where AEs were monitored. Results A total of 7,963 adult men were offered the VMMC service with 7,864 (98.8%) met the age and consent requirements for inclusion in a research follow-up after the surgical procedure and were followed-up for potential AEs. In total, 37 (0.5%) patients reported AEs post-surgery with infection [11 (29.7%)] and excessive bleeding [11 (29.7%)] commonly reported AEs. In terms of severity, 14 (37.8%) were classified as mild, 13 (35.1%) as moderate, and 10 (27.0%) as severe. Further, 32 (86.5%) of the AEs were classified as definitely related to the surgical procedure, with 36 (97.5%) of all AEs resolving without sequelae. Conclusion The VMMC programme was able to reach adult men at high risk of HIV acquisition. Reported AEs in the programme were minimal, with the observed safety profile comparable to clinical trial settings, suggesting that VMMC can be safely administered in a programmatic setting.

scholarly journals Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya

2019 ◽  
Vol 23 (12) ◽  
pp. 3460-3470 ◽  
Author(s):  
Winnie K. Luseno ◽  
Samuel H. Field ◽  
Bonita J. Iritani ◽  
Stuart Rennie ◽  
Adam Gilbertson ◽  
...  
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Psychosocial Distress ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Western Kenya

scholarly journals Age targeting and scale-up of voluntary medical male circumcision in Mozambique

PLoS ONE ◽  
2019 ◽  
Vol 14 (2) ◽  
pp. e0211958 ◽  
Author(s):  
Juan Dent ◽  
Nuno Gaspar ◽  
Emmanuel Njeuhmeli ◽  
Katharine Kripke
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision

scholarly journals Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa

PLoS Medicine ◽  
2011 ◽  
Vol 8 (11) ◽  
pp. e1001129 ◽  
Author(s):  
Kelly Curran ◽  
Emmanuel Njeuhmeli ◽  
Andrew Mirelman ◽  
Kim Dickson ◽  
Tigistu Adamu ◽  
...  
Keyword(s):  
Human Resource ◽  
Male Circumcision ◽  
Scale Up ◽  
Eastern Africa ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Resource Needs

scholarly journals Tetanus Adverse Event after VMMC for HIV Prevention in a Pre-circumcision Tetanus Immunized Male from Uganda: A Case Report

2021 ◽  
pp. 6-10
Author(s):  
E. Lugada ◽  
A. Nyanzi ◽  
D. Bwayo ◽  
H. Musinguzi ◽  
J. Akao ◽  
...  
Keyword(s):  
Case Report ◽  
Male Circumcision ◽  
Scale Up ◽  
Developed Countries ◽  
Local Health ◽  
Voluntary Medical Male Circumcision ◽  
Vaccine Failure ◽  
Medical Male Circumcision ◽  
Post Vaccination ◽  
Tetanus Vaccination

Background: Although tetanus is a life-threatening disease, its occurrence is rare in the post-vaccination era, especially in developed countries. The US President’s Emergency Plan for AIDS Relief (PEPFAR) has supported scale up of Voluntary Medical Male Circumcision (VMCC) to reduce female-to-male HIV transmission in countries with a high prevalence of HIV. VMMC is generally safe, with less than 2% of clients experiencing moderate to severe adverse events. However, in most sub-Saharan countries with a high HIV prevalence and low male circumcision coverage, tetanus vaccination overage among infants, especially male, remains suboptimal. This is a case report of a 45-year-old male who developed tetanus after pre-circumcision tetanus vaccination in a VMMC HIV/AIDS prevention intervention program in Uganda. The Case: A healthy 45-year-old male presented for voluntary circumcision at field VMMC centre. He received a standard pre-circumcision tetanus immunization and had no incident immediate post-operative. 14 days later he reported at a local health facility with a history of difficulty in swallowing, difficulty in breathing, loss of speech and was ultimately diagnosed with tetanus after 2 days. The patient was immediately admitted in intensive care unit, treated, improved and eventually discharged. Conclusions: This report highlights the possibility of tetanus vaccine failure and importance of prompt diagnosis and treatment of tetanus. It also highlights the need for institution of aggressive quality improvement and pre-circumcision tetanus vaccination procedures. Post vaccination surveillance for possible vaccine failure is recommended in addition to a review of existing national immunization medical practice and policies.

scholarly journals Community Engagement for the Voluntary Medical Male Circumcision (VMMC) Program: an Analysis of Key Stakeholder Roles to Promote a Sustainable Program in Zambia

2021 ◽  
Author(s):  
Joseph Mumba Zulu ◽  
Trevor Mwamba ◽  
Alyssa Rosen ◽  
Tulani Francis L. Matenga ◽  
Joseph M Mulanda ◽  
...  
Keyword(s):  
Social Media ◽  
Community Engagement ◽  
Male Circumcision ◽  
Rural Areas ◽  
Health Workers ◽  
Health Centre ◽  
Urban Setting ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Community Stakeholders

Abstract BackgroundWithin the Voluntary Medical Male Circumcision (VMMC) programme, community engagement has been central in facilitating the acceptance of VMMC, especially in non-circumcising communities. To date, there has been inadequate mapping of community stakeholders, their power, roles, and strategies in facilitating sustainability of VMMC programmes. We use the case of the development of community engagement plans for sustainability of VMMC in Zambia to illustrate diversity of stakeholders, their power, roles, and strategies in community engagement. The analysis was guided by the power and interest model.MethodsData were collected using document review, in-depth interviews (n=35) and focus group discussions (n=35) with community stakeholders, health workers, health centre committees, counsellors, teachers, community volunteers and parents/caregivers. Data were analysed using thematic analysis. ResultsDifferences were noted between the rural and urban sites in terms of power/influence and interest rating of community stakeholders who could be involved in the sustainability phase of the VMMC response in Zambia. For example, in the urban setting, neighbourhood health committees (NHCs), health workers, leaders of clubs, community health workers (CHWs), radio, television and social media platforms were ranked highest. From this list, social media and television platforms were not highly ranked in rural areas. Some stakeholders had more sources of power than others. Forms or sources of power included technical expertise (knowledge, skills, roles), local authority (traditional, political, religious leadership), financial resources, collective action (action through schools, churches, media platforms, other community spaces), and relational power (community / family bonds). Key roles and strategies included strengthening community engagement in the planning processes by broadening local coordination and engagement systems, enhancing community involvement in providing VMMC information through the use of locally recognised communication spaces and channels, facilitating ownership of VMMC through promoting a community-led monitoring and evaluation process, as well as improving local accountability processes in VMMC activities.ConclusionBy consulting with the most relevant stakeholders, and considering community needs in programme development, the VMMC programme may be able to leverage the community structures and systems to reduce long term demand generation costs for VMMC and increase the acceptability and frequency of male circumcision.

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