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Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe
BACKGROUND: The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. METHODS AND FINDINGS: A comparative process evaluation was used to examine data from SYMMACS, the Systematic Mo...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011679/ https://www.ncbi.nlm.nih.gov/pubmed/24801073 http://dx.doi.org/10.1371/journal.pone.0079524 |
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author | Jennings, Larissa Bertrand, Jane Rech, Dino Harvey, Steven A. Hatzold, Karin Samkange, Christopher A. Omondi Aduda, Dickens S. Fimbo, Bennett Cherutich, Peter Perry, Linnea Castor, Delivette Njeuhmeli, Emmanuel |
author_facet | Jennings, Larissa Bertrand, Jane Rech, Dino Harvey, Steven A. Hatzold, Karin Samkange, Christopher A. Omondi Aduda, Dickens S. Fimbo, Bennett Cherutich, Peter Perry, Linnea Castor, Delivette Njeuhmeli, Emmanuel |
author_sort | Jennings, Larissa |
collection | PubMed |
description | BACKGROUND: The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. METHODS AND FINDINGS: A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. CONCLUSIONS: Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. |
format | Online Article Text |
id | pubmed-4011679 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-40116792014-05-09 Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe Jennings, Larissa Bertrand, Jane Rech, Dino Harvey, Steven A. Hatzold, Karin Samkange, Christopher A. Omondi Aduda, Dickens S. Fimbo, Bennett Cherutich, Peter Perry, Linnea Castor, Delivette Njeuhmeli, Emmanuel PLoS One Research Article BACKGROUND: The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. METHODS AND FINDINGS: A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. CONCLUSIONS: Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. Public Library of Science 2014-05-06 /pmc/articles/PMC4011679/ /pubmed/24801073 http://dx.doi.org/10.1371/journal.pone.0079524 Text en https://creativecommons.org/publicdomain/zero/1.0/ This is an open-access article distributed under the terms of the Creative Commons Public Domain declaration, which stipulates that, once placed in the public domain, this work may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. |
spellingShingle | Research Article Jennings, Larissa Bertrand, Jane Rech, Dino Harvey, Steven A. Hatzold, Karin Samkange, Christopher A. Omondi Aduda, Dickens S. Fimbo, Bennett Cherutich, Peter Perry, Linnea Castor, Delivette Njeuhmeli, Emmanuel Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe |
title | Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe |
title_full | Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe |
title_fullStr | Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe |
title_full_unstemmed | Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe |
title_short | Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe |
title_sort | quality of voluntary medical male circumcision services during scale-up: a comparative process evaluation in kenya, south africa, tanzania and zimbabwe |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011679/ https://www.ncbi.nlm.nih.gov/pubmed/24801073 http://dx.doi.org/10.1371/journal.pone.0079524 |
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