A program evaluation report of a rapid scale-up of a high-volume medical male circumcision site, KwaZulu-Natal, South Africa, 2010–2013

Abstract

BackgroundMale circumcision can provide life-long reduction in the risk of acquiring HIV infection. In South Africa, the KwaZulu-Natal Provincial Department of Health committed to rolling out circumcision programs to address the HIV epidemic. The Department of Health enlisted the help of St. Mary’s Hospital in Mariannhill and the Operation Abraham Collaborative.MethodsSt. Mary’s Hospital and the Operation Abraham Collaborative partnered to establish a voluntary medical male circumcision facility, called Asiphile, and to train surgeons, nurses and health clinic staff to serve KwaZulu-Natal.ResultsOver the course of the implementation period, 9,980 circumcisions were conducted at the Asiphile facility. The uptake numbers increased throughout 2010 and 2011 and began to level off as the demand of early adopters may have been met. Uptake spiked during school vacations and staff training sessions. Additionally, 92 % of clients returned for post-operation follow-up and only 2 % of clients experienced any adverse event.ConclusionSt. Mary’s Hospital and the Operation Abraham Collaborative were able to cooperate and successfully implement a voluntary medical male circumcision facility in KwaZulu-Natal. Although uptake was lower than projected, lessons learned from efforts to overcome challenges in recruitment, transportation, and coordination can help inform and improve new and existing population-based male circumcision programs.

Trust but verify: Is there a role for active surveillance in monitoring adverse events in Zimbabwe’s large-scale male circumcision program?

“…The indicator of “at least 1 follow-up visit within 14 days of MC” is reported to calculate the follow-up rate on the MRF. During site attachments, GS reported that clients’ spontaneous follow-up appeared lower than the reported 95%, echoing previous studies finding challenges in adherence to post-operative visits [14, 33, 34]. On the client side, in all MC settings, men were counselled on the healing process and where to seek care if needed.…”

Case series of glans injuries during voluntary medical male circumcision for HIV prevention — eastern and southern Africa, 2015–2018

“…Programs are encouraged to determine a safe number of procedures that can be done dependent on a site's composition and resources. One example from South Africa details a team of 3 doctors and 12 nurses being able to circumcise up to 50 patients a day [15]. It is important to document workload in future AE investigations as this may provide quantitative data to inform the investigation and decision making.…”

A prospective cohort study of safety and patient satisfaction of voluntary medical male circumcision in Botswana

“…Studies conducted in other countries have reported lower AE rates (i.e. <2%) but suffered from poor retention [ 6 , 9 , 14 , 15 , 19 , 20 ]. For example, an evaluation of a school-based VMMC campaign in South Africa reported an overall AE rate of 1.2%.…”

“…The current analysis is restricted to data collected at two and seven days post-circumcision because the majority of adverse events occur during or immediately following VMMC and to ensure comparability of our results to previously-published safety studies conducted in other settings [ 12 – 15 ]. Participants were asked to complete a brief questionnaire about wound care, patient satisfaction and resumption of normal activities or work.…”