The risks and benefits of providing HIV services during the COVID-19 pandemic

Introduction The COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services. Methods We used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics. Results Maintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19–146 discounted deaths per 10,000 clients. Discussion While there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

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The Risks and Benefits of Providing HIV Services during the COVID-19 Pandemic

10.1101/2021.03.01.21252663 ◽

2021 ◽

Author(s):

John Stover ◽

Sherrie L. Kelly ◽

Edinah Mudimu ◽

Dylan Green ◽

Tyler Smith ◽

...

Keyword(s):

Health Services ◽

Health Workers ◽

Diagnostic Testing ◽

Simulation Models ◽

Hiv Infections ◽

Early Response ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Hiv Services ◽

Trade Offs

AbstractIntroductionThe COVID-19 pandemic has caused widespread disruptions including to health services. In the early response to the pandemic many countries restricted population movements and some health services were suspended or limited. In late 2020 and early 2021 some countries re-imposed restrictions. Health authorities need to balance the potential harms of additional SARS-CoV-2 transmission due to contacts associated with health services against the benefits of those services, including fewer new HIV infections and deaths. This paper examines these trade-offs for select HIV services.MethodsWe used four HIV simulation models (Goals, HIV Synthesis, Optima HIV and EMOD) to estimate the benefits of continuing HIV services in terms of fewer new HIV infections and deaths. We used three COVID-19 transmission models (Covasim, Cooper/Smith and a simple contact model) to estimate the additional deaths due to SARS-CoV-2 transmission among health workers and clients. We examined four HIV services: voluntary medical male circumcision, HIV diagnostic testing, viral load testing and programs to prevent mother-to-child transmission. We compared COVID-19 deaths in 2020 and 2021 with HIV deaths occurring now and over the next 50 years discounted to present value. The models were applied to countries with a range of HIV and COVID-19 epidemics.ResultsMaintaining these HIV services could lead to additional COVID-19 deaths of 0.002 to 0.15 per 10,000 clients. HIV-related deaths averted are estimated to be much larger, 19 - 146 discounted deaths per 10,000 clients.DiscussionWhile there is some additional short-term risk of SARS-CoV-2 transmission associated with providing HIV services, the risk of additional COVID-19 deaths is at least 100 times less than the HIV deaths averted by those services. Ministries of Health need to take into account many factors in deciding when and how to offer essential health services during the COVID-19 pandemic. This work shows that the benefits of continuing key HIV services are far larger than the risks of additional SARS-CoV-2 transmission.

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

10.21203/rs.3.rs-295480/v1 ◽

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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Cutting-Edge Success in Preventing Heterosexual HIV Transmission in Africa: Voluntary Medical Male Circumcision Has Reached 15 Million Men

AIDS Education and Prevention ◽

10.1521/aeap.2018.30.3.232 ◽

2018 ◽

Vol 30 (3) ◽

pp. 232-242

Author(s):

Inon Schenker

Keyword(s):

Male Circumcision ◽

Randomized Clinical Trials ◽

Hiv Transmission ◽

Hiv Infections ◽

High Volume ◽

Sub Saharan Africa ◽

Voluntary Medical Male Circumcision ◽

Medical Male Circumcision ◽

Sub Saharan ◽

A Minor

Male circumcision is a minor surgery performed for religious and medical reasons. Three randomized clinical trials demonstrated it could reduce heterosexual HIV transmission from infected females to males by over 60%, paving the way in 2006 for multinational efforts to circumcise 27 million men in sub-Saharan Africa by 2021. It is estimated that by 2030 male circumcision will avert at least 500,000 HIV infections in Africa, saving lives and budgets. Voluntary medical male circumcision (VMMC) of adults and adolescents has challenged policy makers, implementers, funders, and civil society in bringing surgery to the frontline of HIV prevention. Five key challenges are discussed: policy, clinical, demand, supply, and scaling up. A unique Israel-Senegal-South Africa collaboration, which enhanced high-volume (100 VMMCs per day) and high-quality (less than 2% minor adverse events) procedures, is described, highlighting VMMC as one of the most impressive public health collaborative interventions in HIV/AIDS prevention globally.

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Assessing the efficacy of an integrated intervention to create demand for fishermen’s schistosomiasis and HIV services (FISH) in Mangochi, Malawi: Study protocol for a cluster randomized control trial

PLoS ONE ◽

10.1371/journal.pone.0262237 ◽

2022 ◽

Vol 17 (1) ◽

pp. e0262237

Author(s):

Donaldson F. Conserve ◽

Sekeleghe Kayuni ◽

Moses K. Kumwenda ◽

Kathryn L. Dovel ◽

Augustine Talumba Choko

Keyword(s):

Social Networks ◽

Self Report ◽

Special Focus ◽

Voluntary Medical Male Circumcision ◽

Presumptive Treatment ◽

Medical Male Circumcision ◽

Hiv Services ◽

Link Type ◽

Self Test ◽

Cluster Randomized

Background Both HIV and schistosomiasis are major public health problems worldwide with 1.8 million new HIV infections, and up to 110 million untreated schistosomiasis cases globally. Although a causal link has not been established, there are strong suggestions that having schistosomiasis increases onward transmission of HIV from co-infected men to women. With both HIV and schistosomiasis treatment readily available in Malawi, there is a need to investigate the feasibility, acceptability and health impacts of joint management of these two hazards, with special focus on health education and demand-creation for fishermen. The aim of this project is to identify optimal models of delivering integrated HIV and schistosomiasis services for fishermen, particularly investigating the effect of using social networks, HIV self-test kits and beach clinic services in Mangochi, Malawi. Methods We have mapped 45 boat teams or landing sites for a 3-arm cluster randomized trial using “boat team” as the unit of randomization. The three arms are: 1) Standard of care (SOC) with leaflets explaining the importance of receiving presumptive treatment for schistosomiasis (praziquantel) and HIV services for fishermen, and two intervention arms of 2) SOC + a peer explaining the leaflet to his fellow fishermen in a boat team; and 3) arm 2 with HIV self-test kits delivered to the boat team fishermen by the peer. The primary outcomes measured at 9 months of trial delivery will compare differences between arms in the proportions of boat-team fishermen: 1) who self-report starting antiretroviral therapy or undergoing voluntary medical male circumcision; and 2) who have ≥1 S. haematobium egg seen on light microscopy of the filtrate from 10mls urine (“egg-positive”). Discussion This is the first evaluation of an integrated HIV and schistosomiasis services intervention for fishermen, particularly investigating the effect of using social networks, HIVST kits and beach clinic services. The findings will support future efforts to integrate HIVST with other health services for fishermen in similar settings if found to be efficacious. Trial registration This trial is registered in the ISRCTN registry: ISRCTN14354324; date of registration: 05 October 2020. https://www.isrctn.com/ISRCTN14354324?q=ISRCTN14354324&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search. Linked to protocol version number 1.4 of 11 January 2021.

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Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review

PLoS ONE ◽

10.1371/journal.pone.0149892 ◽

2016 ◽

Vol 11 (3) ◽

pp. e0149892 ◽

Cited By ~ 27

Author(s):

Michelle R. Kaufman ◽

Marina Smelyanskaya ◽

Lynn M. Van Lith ◽

Elizabeth C. Mallalieu ◽

Aliza Waxman ◽

...

Keyword(s):

Reproductive Health ◽

Health Services ◽

Literature Review ◽

Systematic Literature Review ◽

Male Circumcision ◽

Sexual And Reproductive Health ◽

Voluntary Medical Male Circumcision ◽

Reproductive Health Services ◽

Medical Male Circumcision

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Health workers’ perspectives on implementation of an integrated medical male circumcision strategy in KwaZulu-Natal, South Africa

Health SA Gesondheid ◽

10.4102/hsag.v19i1.810 ◽

2014 ◽

Vol 19 (1) ◽

Author(s):

Rogerio Phili

Keyword(s):

Public Sector ◽

Hiv Infection ◽

Male Circumcision ◽

Health Workers ◽

Voluntary Medical Male Circumcision ◽

Reproductive Health Services ◽

Medical Male Circumcision ◽

Missed Opportunities ◽

Kwazulu Natal ◽

Randomised Controlled

Background: KwaZulu-Natal province began implementation of voluntary medical male circumcision (VMMC) as an integral part of its HIV infection prevention strategy that includes other programmes such as HIV counselling and testing (HCT), screening and treatment of sexually transmitted infections and tuberculosis, and other sexual and reproductive health services. This followed randomised controlled trials that showed up to 60% HIV infection risk reduction amongst circumcised men. Implementation of the strategy occurred despite absence of knowledge of operational barriers and its acceptability to health care workers (HCWs).Objectives: The study aimed to explore HCWs’ perspectives of and barriers to strategy implementation at public sector health facilities to inform implementation policy.Method: A purposive quota sampling method was used to select HCWs for focus group discussions at three study sites. Participants were asked open-ended questions using an interview schedule based on a literature review to explore acceptability of and perceptions regarding provision of the strategy. Thematic analysis was conducted.Results: Acceptability of the strategy was high amongst the participants; however, there was limited knowledge of some key concepts of the strategy, personnel role confusion, missed opportunities for client recruitment, and infrastructural constraints. Negative perceptions included beliefs that VMMC would discourage condom use and cause stigma associated with non-circumcision of HIV-positive males, with perceptions of sexual behavioural disinhibition in circumcised men.Conclusion: There is a need to engage further with stakeholders if implementation of VMMC is to be successful. More training and support needs to be provided to HCWs at public sector facilities.Agtergrond: Die implementering van vrywillige mediese manlike besnyding (VMMC) is ’n integrale deel van KwaZulu-Natal provinsie se MIV-voorkomingstrategie, wat ander programme soos MIV-berading, siftingstoetse (HCT) en die behandeling van seksuele oordraagbare siektes (STI), asook ander seksuele en reproduksie-gesondheidsdienste (geïntegreerde VMMC) insluit. Dit volg op die resultate van ewekansige gekontroleerde steekproewe wat ’n doeltreffendheid getoon het van tot 60% vermindering in HIV-risiko onder mans wat besny is. Die implementering van die strategie het plaasgevind ten spyte van die afwesigheid van kennis van operasionele struikelblokke of aanvaarding deur gesondheidswerkers (HCWs).Doelwitte: Die studie is daarop gerig om HCW se perspektiewe en hindernisse vir die implementering van die VMMC program by die openbare sektor se gesondheidsfasiliteite te verken, ten einde die uitvoering van die beleid vas te stel.Metode: Die doelgerigte kwotasteekproefmetode is gebruik om HCW deelnemers vir fokusgroepbesprekings (FGDs) op drie studieterreine te kies. Deelnemers is oop vrae gevra met behulp van ’n onderhoudskedule gebaseer op ’n literatuuroorsig van die aanvaarbaarheid en persepsies aangaande die voorsiening van die strategie. Tematiese analise is in ooreenstemming met die doelwitte van die studie gedoen.Resultate: Die aanvaarbaarheid van VMMC was hoog onder die deelnemers, maar ’n paar probleemareas is geïdentifieer: beperkte kennis van belangrike begrippe van die strategie, personeelrolverwarring, geleenthede vir kliëntwerwing en infrastruktuurbeperkings. Negatiewe persepsies het ingesluit: oortuigings dat VMMC die gebruik van kondome sou voorkom, die stigma wat verband hou met onbesnede HIV-positiewe mans en die persepsie van onderdrukte seksuele gedrag by mans wat besny is.

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

African Journal of Urology ◽

10.1186/s12301-021-00156-8 ◽

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.

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