Healthcare providers’ knowledge, attitudes and practices towards medical male circumcision and their understandings of its partial efficacy in HIV prevention: Qualitative research in KwaZulu-Natal, South Africa

Abstract

Background Medical male circumcision has been shown to reduce HIV transmission to an uninfected male partner. In South Africa, medical male circumcision programs were rolled-out in 2010. Objectives Prior to roll-out, we explored healthcare providers’ knowledge, attitudes and practices about medical male circumcision and their understandings of partial efficacy for HIV prevention. Design We conducted qualitative research, using in-depth interviews. Setting Participants were from three rural and three urban primary healthcare clinics, randomly selected in eThekwini District, KwaZulu-Natal. Participants 25 healthcare providers (including nurse managers, nurses and counselors) were purposively selected from the clinics. Methods In-depth interviews were recorded, transcribed and translated. Independent researchers reviewed the transcripts and developed a codebook based on emergent themes, using thematic analysis. NVivo 8 was used to facilitate data management, coding and analysis. Results Although most providers had heard that medical male circumcision can reduce risk of HIV acquisition in men, most did not have accurate scientific understandings of this. Some providers had misperceptions about the limited/partial protection medical male circumcision offers. Many had concerns that their communities would misunderstand it, causing increased risky sexual behavior. Conclusions These data provide a baseline of providers’ understandings of medical male circumcision prior to roll-out, and can be used to compare current data and ensure accurate messaging to clients. Healthcare provider messaging should build client understandings of the meaning of partially efficacious technologies.

‘Why would you promote something that is less percent safer than a condom?’: Perspectives on partially effective HIV prevention technologies among key populations in South Africa

“…Third, HCWs shared substantial misgivings about the promotion of partially efficacious NPTs; yet, their support is crucial to the dissemination of these products (Milford et al., 2016 ). Addressing concerns that partially effective NPTs may encourage risk compensation behaviour or that NPTs may specifically discourage condom use is paramount, particularly in the face of competing evidence in regard to actual risk compensation behaviour (e.g.…”

“…The concept of ‘partial efficacy’ is complex and may be difficult to explain (Layer, Beckham, Momburi, & Kennedy, 2013 ; Newman, Duan, Rudy, Roberts, & Swendeman, 2004 ; Underhill et al., 2016 ); even health care providers report erroneous understandings (Milford et al., 2016 ). Yet it is essential for individuals using NPTs to understand that these products are only partially efficacious.…”

“…Existing studies document challenges with understanding partial efficacy, and highlight the importance of sound communication, education, and community engagement efforts with key populations in planning for product implementation (L'Engle, Lanham, Loolpapit, & Oguma, 2014 ; Milford et al., 2016 ; Newman, Duan, Kakinami, & Roberts, 2008 ). However, few studies to date have investigated in-depth understandings of ‘partial efficacy’ among key populations.…”

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

“…Data on the perceptions of VMMC currently appears to be limited to the perceptions of pharmacy and nursing students (13). Research on health care workers' attitudes and understanding of VMMC emanates from a time prior to the roll-out of VMMC in South Africa (14), while current data on health care workers' attitudes and perceptions of implementing VMMC are limited to two regions in Africa, both of which are urban settings (15,16).…”

Efficacy of knowledge and competence‐based training of non‐physicians in the provision of early infant male circumcision using the Mogen clamp in Rakai, Uganda

“…Providers’ knowledge of both didactic material and practical skills is highly variable . A South African study found that most providers knew that circumcision significantly reduced the risk of HIV acquisition in men, but most did not have the knowledge to communicate this to clients . Common provider training deficiencies included screening for contraindications, provision of effective analgesia, and managing AEs .…”