scholarly journals The development of an explanatory model for voluntary medical male circumcision in KwaZulu-Natal, South Africa

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Primary Healthcare ◽  
Explanatory Model ◽  
Outcome Variable ◽  
Care Practice ◽  
Model Description ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Background: KwaZulu-Natal (KZN) remains the epicentre of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic in South Africa. The incidence of HIV infection in KZN necessitates cost-effective strategies to curb the spread of infection. Voluntary medical male circumcision (VMMC) has been adopted as an additional biomedical preventive strategy since 2010 in line with recommendations from the World Health Organization. Despite several attempts to scale-up VMMC to reach age specific targets to achieve immediate aversion of infections, the uptake of VMMC remains sub-optimal, particularly in KZN. The purpose of this study is to describe the processes that were followed in developing, describing and evaluating an explanatory model for VMMC in KZN, South Africa.Methods: A qualitative theory-generative phenomenographic study design was used to analyse the qualitative differences in primary healthcare stakeholders’ experiences, understanding and conceptions of VMMC in KZN, South Africa. The emerging results informed the development of the VMMC explanatory model for KZN, South Africa. The model development process followed four steps, namely (1) concept analysis, (2) construction of relational statements, (3) model description and (4) model evaluation. The criteria of relevance for the target audience – applicability, clarity, user friendliness and originality of work – were used to evaluate the model.Results: The model’s central premise is that the decision to undergo VMMC is shaped by a complex interplay of factors in the context or external environment of males (the extrinsic variable), which influences specific experiences, conceptions and understanding regarding VMMC (the influential/intrinsic variables). These collectively determine men’s responses to VMMC (the outcome variable).Conclusion: The model describes the process by which contextual, extrinsic and intrinsic variables interact to determine an individual male’s response to VMMC, thus providing a guide to primary healthcare providers on care, practice and policy interventions to support the uptake of VMMC in the rural primary healthcare context of KZN, South Africa.

scholarly journals Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa

PLoS ONE ◽  
2014 ◽  
Vol 9 (5) ◽  
pp. e96468 ◽  
Author(s):  
Carl Montague ◽  
Nelisiwe Ngcobo ◽  
Gethwana Mahlase ◽  
Janet Frohlich ◽  
Cheryl Pillay ◽  
...  
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
School Based ◽  
Kwazulu Natal

scholarly journals Healthcare providers’ perceptions and understanding of voluntary medical male circumcision in KwaZulu-Natal, South Africa: A qualitative study

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Healthcare Workers ◽  
Scale Up ◽  
Healthcare Providers ◽  
Structured Interview ◽  
Heterosexual Transmission ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Background: There is compelling evidence that voluntary medical male circumcision (VMMC) reduces the chances of heterosexual transmission of HIV infection. Healthcare workers are among the key influencers in terms of the scale-up of VMMC as they are often involved in mobilisation for uptake. There is a paucity of qualitative research on healthcare workers’ experiences, understanding and perceptions of VMMC; particularly in the South African rural primary healthcare context. This study was conducted to examine healthcare workers perceptions and understanding of VMMC in KwaZulu-Natal, South Africa.Methods: The study employed a qualitative approach using a phenomenographic design. A purposive sample of 15 doctors, nurses and clinical associates working in 6 different rural clinics in KwaZulu-Natal, South Africa, were interviewed in English in-depth using a semi-structured interview schedule. The interviews were audio-recorded, and transcribed. The results were analysed thematically using phenomenographic data analysis procedures.Results: Categories of description in participants’ perceptions and understanding of VMMC emerged. The findings of this study revealed that healthcare workers perceptions and understanding of VMMC were predominantly influenced by the hegemonic religious and cultural norms associated with male circumcision in KwaZulu-Natal, South Africa.Conclusion: The findings of this study suggest that tailored training to address healthcare workers misperceptions and poor understanding of VMMC is necessary to ensure that they become effective custodians for VMMC implementation.

scholarly journals Zulu Men’s Conceptions, Understanding, and Experiences of Voluntary Medical Male Circumcision in KwaZulu-Natal, South Africa

2020 ◽  
Vol 14 (2) ◽  
pp. 155798831989243
Author(s):  
Celenkosini Thembelenkosini Nxumalo ◽  
Gugu Gladness Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Low Income ◽  
Cultural Beliefs ◽  
Scale Up ◽  
Rural Setting ◽  
Voluntary Medical Male Circumcision ◽  
Semistructured Interview ◽  
Medical Male Circumcision ◽  
Kwazulu Natal

Voluntary Medical Male Circumcision (VMMC) is proven to reduce transmission of HIV/AIDS. Despite concerted efforts to scale up VMMC in men aged 18–49, the number of medically circumcised men in this age group remains suboptimal. Research has shown that several individual factors hinder and promote uptake of VMMC. The nature of these factors is not clearly understood within the dimensions of religion, culture and tradition, particularly in a low-income rural setting. This study aimed to analyze Zulu men’s conceptions, understanding and experiences regarding VMMC in KwaZulu-Natal (KZN), South Africa. A qualitative phenomenographic study approach was used to collect data from 20 uncircumcised males at six different clinics that provide VMMC services. Ethical approval to collect data was obtained from the Biomedical Research Ethics Committee of the University of KZN (BREC – BE627/18). Individual in-depth face to face interviews were conducted using a semistructured interview guide. Audiotapes were used to record interviews which were transcribed verbatim and then analyzed manually. The conceptions regarding medical circumcision appeared to be related to religious and cultural beliefs surrounding circumcision and the historical traditional practice thereof. The understanding of males regarding VMMC was mainly attributed to HIV prevention; however, knowledge on the degree of partial protection appeared to be limited. An array of negative accounted in the form of complications such as poor wound healing and postoperative pain undergone by peers and other close influencers’ accounted for participants’ experiences of VMMC. Poor knowledge and negative experiences relating to VMMC could account for reasons why men choose not to undergo VMMC.

scholarly journals Healthcare workers’ perceptions and experiences of implementing voluntary medical male circumcision in KwaZulu-Natal, South Africa

2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Health Care ◽  
Male Circumcision ◽  
Health Care Workers ◽  
Healthcare Workers ◽  
World Health ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Care Workers ◽  
Kwazulu Natal

Background: Voluntary Medical Male Circumcision (VMMC) is an effective HIV prevention strategy prioritized by the World Health Organisation (WHO) for regions of high HIV prevalence, South Africa (SA) and in particular KwaZulu-Natal (KZN) is one of such regions. Since the roll out of VMMC in 2010 there has been little research conducted on the implementation of this service. Existing studies on the uptake of VMMC have mainly focused on service users resulting in a paucity of data on health care workers perspectives on the intervention.Aim: To analyse health care workers’ perceptions and experiences of implementing voluntary medical male circumcision in KZN, SA.Setting: The study took place at six different health districts and their six respective rural clinics in the KZN province of SA.Methods: A qualitative approach using a phenomenographic design was employed. Data were collected from a sample of 18 participants comprising of health care providers (n = 12) and health policy makers (n = 6). Individual, face-to-face interviews were conducted using a semi-structured interview guide. An audiotape was used to record the data, which were transcribed verbatim and then analysed using a step-wise phenomenographic data analysis procedure.Results: Participants reported that VMMC was implemented by the department of health with support from non-governmental organisations and private general practitioners. Negative perceptions and negative experiences regarding VMMC and implementation were reported.Conclusion: The implementation of VMMC is compromised due to poor preparation and training of healthcare workers for implementing the service. Addressing health care workers’ needs for training and preparation is crucial for successful implementation of VMMC.

scholarly journals Prevalence and Associated Risk Factors of Preputial and Penile Abnormalities Among Voluntary Medical Male Circumcision Clients in KwaZulu-Natal Province, South Africa

2021 ◽  
Author(s):  
Mohammad A Quazi ◽  
Donna Jacobs ◽  
Freck Dikgale ◽  
Peter Nyasulu ◽  
James Ndirangu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Cost Effective ◽  
Voluntary Medical Male Circumcision ◽  
Related Factors ◽  
Medical Male Circumcision ◽  
Review Period ◽  
Kwazulu Natal ◽  
Centre Of Excellence ◽  
Associated Risk Factors

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.

scholarly journals Circumcised men’s perceptions, understanding and experiences of voluntary medical male circumcision in KwaZulu-Natal, South Africa

2020 ◽  
Vol 62 (1) ◽  
Author(s):  
Celenkosini T. Nxumalo ◽  
Gugu G. Mchunu
Keyword(s):  
South Africa ◽  
Male Circumcision ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Individual Interviews ◽  
Kwazulu Natal ◽  
Health Related ◽  
Service Training ◽  
And Performance ◽  
The University

Background: KwaZulu-Natal, South Africa, has rolled out voluntary medical male circumcision (VMMC) in response to recommendations that regions with a high human immunodeficiency virus (HIV) prevalence adopt VMMC as an additional HIV prevention strategy. There is a paucity of South African data on the motivators, barriers and experiences of adult male candidates regarding VMMC. This study was conducted to analyse circumcised men’s perceptions, understanding and experiences of VMMC in KwaZulu-Natal, South Africa.Methods: A qualitative phenomenographic design was used. Ethical clearance was obtained from the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BE 627/18). Data were collected from 12 circumcised male candidates. Individual interviews were conducted and recorded by using an audiotape. Data were transcribed verbatim and analysed manually.Results: Participants’ perceptions regarding VMMC are health related and appear to be the motivators for the uptake of medical circumcision. Circumcised men in this study appeared to misunderstand VMMC in terms of healing and performance time and the nature of the procedure. Negative experiences in terms of quality of care received were reported.Conclusion: The study findings imply that practice interventions to promote demand generation for VMMC in KwaZulu-Natal, South Africa, should incorporate the perceptions and experiences of male candidates regarding the procedure. Tailored messaging to address misunderstanding related to the nature of VMMC should also be provided. Regular in-service training on standardised VMMC implementation practices should be provided to ensure the delivery of optimum quality VMMC services.

scholarly journals Health care service providers’ experiences, understanding and conceptions of voluntary medical male circumcision in KwaZulu-Natal, South Africa

2019 ◽  
Author(s):  
Celenkosini Thembelenkosini Nxumalo ◽  
Gugu Gladness Mchunu
Keyword(s):  
South Africa ◽  
Health Care ◽  
Male Circumcision ◽  
Health Care Workers ◽  
Service Providers ◽  
Health Care Service ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Care Workers ◽  
Kwazulu Natal

ABSTRACTBackgroundThere is compelling evidence that voluntary medical male circumcision reduces the chances of heterosexual transmission of HIV infection. Health care workers are among the key influencers in terms of scale up of VMMC as they are often involved in mobilization for uptake. Adequate knowledge and competence are essential to ensuring that the delivery of VMMC services is line with the recommended comprehensive package of HIV prevention services.AimThe aim of this study was to analyse health care service providers’ conceptions, experiences and understanding of VMMC in KwaZulu-Natal, South Africa.MethodsThe study employed a qualitative approach using a phenomenographic design. Ethical clearance to conduct the study was obtained from the University of KwaZulu-Natal’s Biomedical Research Ethics Committee (BE627/18).Data were collected from a purposive sample of 15 health care worker who were doctors, nurses and clinical associates working in six different rural clinics in KwaZulu-Natal, South Africa. Individual in-depth interviews were used collect data guided by a semi-structured interview schedule. An audiotape was used to record the interviews, which were then transcribed verbatim, and analysed thematically.ResultsCategories of description in healthcare providers’ experiences, conceptions and understanding of voluntary medical male circumcision emerged. The findings of this study revealed that health care workers conceptions, experiences and understanding of VMMC were influenced by stereotypical cultural, religious and traditional beliefs. The challenges of implementing VMMC were shortage of staff and poor training of health care workers on VMMC.ConclusionTailored messaging targeting health care workers misconceptions and poor understanding of VMMC in necessary. In addition, resource allocation for training and infrastructure could significantly improve the quality of VMMC services and uptake thereof.

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