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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Global Health: Science and Practice
2014
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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 |
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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 |
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