Abstract
BackgroundVoluntary Medical male circumcision (VMMC) has been identified as a cost-effective intervention for reducing the transmission of HIV. KwaZulu-Natal (KZN), the second most populous province in South Africa, has the highest HIV prevalence, estimated at 27%. VMMC reduces the transmission of HIV by up to 60%; at initiation of VMMC Program in 2010, the KZN VMMC target was 2.4 million, almost 50% of the national target, among males aged 15-49 years. This paper documents the prevalence of penile abnormalities and related factors among clients undergoing VMMC procedures in KwaZulu-Natal province. MethodsA retrospective review of files was conducted among VMMC clients at the Centre of Excellence (a referral centre in the KZN province) and data was captured from a standardized client form into an Excel database. The data was analysed using STATA 15.0. Univariate and multivariate analysis were done using Logistic regression was used to determine factors associated with penile abnormalities. ResultsDuring the review period, 6,650 males accessed VMMC services; the median age was 13 years (IQR 9 – 21). A total of 227 (3.4%) of the clients were HIV-Positive, about 80% of these aged ≥13 years. Upon physical examination, 5,366 (80.6%) of the VMMC clients had penile abnormalities (Mild 781, Moderate 2,282, Severe 2,303). Overall, 43% of these clients had severe penile abnormalities (SPA); two-thirds were aged below 13 years and 10% aged above 34 years. The three most common Penile Abnormalities (PA) were phimosis (3,686; 55.4%), tight ring (3,669; 55.2%) and overhanging foreskin (2,966; 44.6%). The odds of penile abnormality were significantly lower in older clients aged 13–18 years (AOR = 0.74; 95% CI = 0.59–0.87) and above 18 years (AOR = 0.15; 95% CI = 0.10–0.29) compared to younger clients aged below 13 years.ConclusionsA higher prevalence of Penile Abnormalities was observed among the younger clients except for balanitis / posthitis. Recommendations for VMMC program include the fact that all clients need to be examined thoroughly preoperatively to exclude any abnormalities. Any clients with severe abnormalities should be referred for specialist examination and surgery.