Cargando…

Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study

BACKGROUND: Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. The Government of Kenya is rolling out voluntary medical male circumcision (VMMC) services, but struggles with health worker shortages, particularly with physician shortages. OBJECTIV...

Descripción completa

Detalles Bibliográficos
Autores principales: Frajzyngier, Vera, Odingo, George, Barone, Mark, Perchal, Paul, Pavin, Melinda
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Global Health: Science and Practice 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168600/
https://www.ncbi.nlm.nih.gov/pubmed/25276565
http://dx.doi.org/10.9745/GHSP-D-13-00120
_version_ 1782335578059046912
author Frajzyngier, Vera
Odingo, George
Barone, Mark
Perchal, Paul
Pavin, Melinda
author_facet Frajzyngier, Vera
Odingo, George
Barone, Mark
Perchal, Paul
Pavin, Melinda
author_sort Frajzyngier, Vera
collection PubMed
description BACKGROUND: Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. The Government of Kenya is rolling out voluntary medical male circumcision (VMMC) services, but struggles with health worker shortages, particularly with physician shortages. OBJECTIVE: To evaluate the safety of male circumcision performed by non-physician clinicians in Kenya. METHODS: Between December 2009 and December 2010, we conducted a prospective study of VMMC procedures performed by 15 nurses and 11 clinical officers, all trained to competence, in 11 public health facilities in Nyanza Province, Kenya. Providers reported surgical complications and adverse events (AEs), based on standardized definitions, immediately after the procedure and at 7 days and 60 days post-circumcision. We also assessed clients' satisfaction with the circumcision at 60 days. RESULTS: We recruited 2,244 men and boys, ages 13–54. The retention rate was high, with 2,192 participants (98%) returning for the 7-day follow-up visit and 1,845 (82%) for the 60-day visit. There was no difference in rates of moderate and severe AEs between participants whose circumcision was performed by a nurse (2.1%) or a clinical officer (1.9%) at 7 days post-circumcision. The most common AE was excess swelling (1.1%). Risk factors associated with an AE at 7 days post-circumcision included being employed and participant age ≥ 18 years. Participants circumcised by a provider with ≥ 6 years of professional experience were less likely to have an AE. Nearly all participants reported being satisfied with their circumcision at the 60-day follow-up visit. CONCLUSIONS: Trained nurses and clinical officers provided safe VMMC in Nyanza Province, Kenya. AE rates in this study were similar to those reported in typical service-delivery settings. These results add to the current body of evidence suggesting that trained non-physicians can provide safe medical male circumcision, thereby facilitating increased availability and access to circumcision services.
format Online
Article
Text
id pubmed-4168600
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher Global Health: Science and Practice
record_format MEDLINE/PubMed
spelling pubmed-41686002014-09-30 Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study Frajzyngier, Vera Odingo, George Barone, Mark Perchal, Paul Pavin, Melinda Glob Health Sci Pract Original Articles BACKGROUND: Male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. The Government of Kenya is rolling out voluntary medical male circumcision (VMMC) services, but struggles with health worker shortages, particularly with physician shortages. OBJECTIVE: To evaluate the safety of male circumcision performed by non-physician clinicians in Kenya. METHODS: Between December 2009 and December 2010, we conducted a prospective study of VMMC procedures performed by 15 nurses and 11 clinical officers, all trained to competence, in 11 public health facilities in Nyanza Province, Kenya. Providers reported surgical complications and adverse events (AEs), based on standardized definitions, immediately after the procedure and at 7 days and 60 days post-circumcision. We also assessed clients' satisfaction with the circumcision at 60 days. RESULTS: We recruited 2,244 men and boys, ages 13–54. The retention rate was high, with 2,192 participants (98%) returning for the 7-day follow-up visit and 1,845 (82%) for the 60-day visit. There was no difference in rates of moderate and severe AEs between participants whose circumcision was performed by a nurse (2.1%) or a clinical officer (1.9%) at 7 days post-circumcision. The most common AE was excess swelling (1.1%). Risk factors associated with an AE at 7 days post-circumcision included being employed and participant age ≥ 18 years. Participants circumcised by a provider with ≥ 6 years of professional experience were less likely to have an AE. Nearly all participants reported being satisfied with their circumcision at the 60-day follow-up visit. CONCLUSIONS: Trained nurses and clinical officers provided safe VMMC in Nyanza Province, Kenya. AE rates in this study were similar to those reported in typical service-delivery settings. These results add to the current body of evidence suggesting that trained non-physicians can provide safe medical male circumcision, thereby facilitating increased availability and access to circumcision services. Global Health: Science and Practice 2014-01-09 /pmc/articles/PMC4168600/ /pubmed/25276565 http://dx.doi.org/10.9745/GHSP-D-13-00120 Text en © Frajzyngier et al. http://creativecommons.org/licenses/by/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/
spellingShingle Original Articles
Frajzyngier, Vera
Odingo, George
Barone, Mark
Perchal, Paul
Pavin, Melinda
Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
title Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
title_full Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
title_fullStr Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
title_full_unstemmed Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
title_short Safety of adult medical male circumcision performed by non-physician clinicians in Kenya: a prospective cohort study
title_sort safety of adult medical male circumcision performed by non-physician clinicians in kenya: a prospective cohort study
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168600/
https://www.ncbi.nlm.nih.gov/pubmed/25276565
http://dx.doi.org/10.9745/GHSP-D-13-00120
work_keys_str_mv AT frajzyngiervera safetyofadultmedicalmalecircumcisionperformedbynonphysiciancliniciansinkenyaaprospectivecohortstudy
AT odingogeorge safetyofadultmedicalmalecircumcisionperformedbynonphysiciancliniciansinkenyaaprospectivecohortstudy
AT baronemark safetyofadultmedicalmalecircumcisionperformedbynonphysiciancliniciansinkenyaaprospectivecohortstudy
AT perchalpaul safetyofadultmedicalmalecircumcisionperformedbynonphysiciancliniciansinkenyaaprospectivecohortstudy
AT pavinmelinda safetyofadultmedicalmalecircumcisionperformedbynonphysiciancliniciansinkenyaaprospectivecohortstudy