Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe

Feldacker, Caryl; Makunike-Chikwinya, Batsirai; Holec, Marrianne; Bochner, Aaron F.; Stepaniak, Abby; Nyanga, Robert O; Xaba, Sinokuthemba; Kilmarx, Peter H.; Herman‐Roloff, Amy; Tafuma, Taurayi A.; Tshimanga, Mufuta; Sidile-Chitimbire, Vuyelwa; Barnhart, Scott

doi:10.1080/16549716.2017.1414997

Cited by 23 publications

(23 citation statements)

References 32 publications

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“…Between March 2013 and March, 2017, ZAZIC supported MC services for males age 10 and older, performing 192,575 MCs within 21 districts: 20,987 PrePex (10.9%) and 171,588 surgical (89.1%)[ 16 ]. Three circumcision techniques were used over the study period: surgical forceps-guided MC was approved for clients ages 15 and above; surgical dorsal slit was approved for clients ages 10 and above; and PrePex was approved for clients ages 15 and above.…”

Section: Methodsmentioning

confidence: 99%

Timing of adverse events among voluntary medical male circumcision clients: Implications from routine service delivery in Zimbabwe

Feldacker¹,

Bochner²,

Murenje³

et al. 2018

PLoS ONE

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BackgroundTiming of routine follow-up visits after adult male circumcision (MC) differs by country and method. Most men do not attend all routine follow-up visits. This cross-sectional study aimed to further understanding of AE timing within a large-scale, routine, MC program to improve patient safety.MethodsFrom 2013–2017, ZAZIC consortium performed 192,575 MCs in Zimbabwe; the reported adverse event (AE) rate was 0.3%. Three scheduled, routine, follow-up visits intend to identify AEs. For surgical MC, visits were days 2, 7 and 42 post-procedure. For PrePex (device-based), visits were days 7, 14 and 49. Descriptive statistics explored characteristics of those patients with AEs. For each MC method, chi-square tests were used to evaluate associations between AE timing (days from MC to AE diagnosis) and factors of interest (age, AE type, severity).ResultsOf 421 AEs, 290 (69%) were surgical clients: 55 (19%) AEs were ≤2 days post-MC; 169 (58%) between 3–7 days; 47 (16%) between days 8–14; and 19 (7%) were ≥15 post-MC. Among surgical clients, bleeding was most common AE on/before Day 2 while infections predominated in other follow-up periods (p<0.001). Younger surgical MC patients with AEs experienced AEs later than older clients (p<0.001). Among 131 (31%) PrePex clients with AEs, 46 (35%) were ≤2 days post-MC; 59 (45%) between 3–7 days; 16 (12%) between days 8–14; and 10 (7%) ≥15 post-MC. For PrePex clients, device displacements were more likely to occur early while late AEs were most commonly infections (p<0.001).ConclusionAlmost 23% of surgical and 8% of PrePex AEs occurred after Visit 2. Later AEs were likely infections. Clinicians, clients, and caregivers should be more effectively counseled that complications may arise after initial visits. Messages emphasizing attention to wound care until complete healing could help ensure client safety. Younger boys, ages 10–14, and their caregivers would benefit from improved, targeted, post-operative counseling.

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Section: Methodsmentioning

confidence: 99%

Timing of adverse events among voluntary medical male circumcision clients: Implications from routine service delivery in Zimbabwe

Feldacker¹,

Bochner²,

Murenje³

et al. 2018

PLoS ONE

Self Cite

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“…To reach men, alternative approaches to household testing may be needed, since only~40% of our survey participants were male, similar to other household surveys. When male-oriented health interventions exist in Africa, such as voluntary medical male circumcision [29], integrating HBsAg testing may be an efficient way to identify men and link them to care.…”

Section: Discussionmentioning

confidence: 99%

Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia

et al. 2020

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IntroductionWe evaluated antiviral therapy (AVT) eligibility in a population-based sample of adults with chronic hepatitis B virus (HBV) infection in Zambia. Materials and methodsUsing a household survey, adults (18+ years) were tested for hepatitis B surface antigen (HBsAg). Sociodemographic correlates of HBsAg-positivity were identified with multivariable regression. HBsAg-positive individuals were referred to a central hospital for physical examination, elastography, and phlebotomy for HBV DNA, hepatitis B e antigen, serum transaminases, platelet count, and HIV-1/2 antibody. We determined the proportion of HBV monoinfected adults eligible for antiviral therapy (AVT) based on European Association for the Study of the Liver (EASL) 2017 guidelines. We also evaluated the performance of two alternative criteria developed for use in sub-Saharan Africa, the World Health Organization (WHO) and Treat-B guidelines. ResultsAcross 12 urban and 4 rural communities, 4,961 adults (62.9% female) were tested and 182 (3.7%) were HBsAg-positive, 80% of whom attended hospital follow-up. HBsAg-positivity was higher among men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 0.99-1.87) and with decreasing income (AOR, 0.89 per household asset; 95% CI, 0.81-0.98). Trends toward higher HBsAg-positivity were also seen at ages 30-39 years (AOR, 2.11; 95% CI, 0.96-4.63) and among pregnant women (AOR, 1.74; 95% CI, 0.93-3.25). Among HBV monoinfected individuals (i.e., HIV-negative) evaluated for AVT, median age PLOS ONE | https://doi.

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“…This may be due to a lower proportion of men diagnosed in 2017 compared to women, and hence, there is more scope for this estimate to increase. It is hoped that these estimates may increase even further, in line with increased efforts in testing for HIV in men, within for example the circumcision programme currently underway in Zimbabwe 19 and with the planned rollout of HIV self‐testing which is likely to attract a significant proportion of men (TA, Zimbabwe MoH, personal communication). The proportion of people with NNRTI resistance at ART initiation is also projected to increase by 9% to an overall 15% by 2020.…”

Section: Discussionmentioning

confidence: 99%

90‐90‐90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe – 2017 to 2020

Bansi‐Matharu¹,

Cambiano²,

Apollo

et al. 2018

J Intern AIDS Soc

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IntroductionThe 90‐90‐90 targets set by the United Nations aspire to 73% of people living with HIV (PLHIV) being virally suppressed by 2020. Using the HIV Synthesis Model, we aim to mimic the epidemic in Zimbabwe and make projections to assess whether Zimbabwe is on track to meet the 90‐90‐90 targets and assess whether recently proposed UNAIDS HIV transition metrics are likely to be met.MethodsWe used an approximate Bayesian computation approach to identify model parameter values which result in model outputs consistent with observed data, evaluated using a calibration score. These parameter values were then used to make projections to 2020 to compare with the 90‐90‐90 targets and other key indicators. We also calculated HIV transition metrics proposed by UNAIDS (percentage reduction in new HIV infections and AIDS‐related mortality from 2010 to 2020, absolute rate of new infections and AIDS‐related mortality, incidence–mortality ratio and incidence–prevalence ratios).ResultsAfter calibration, there was general agreement between modelled and observed data. The median predicted outcomes in 2020 were: proportion of PLHIV (aged 15 to 65) diagnosed 0.91 (90% uncertainty range 0.87, 0.94) (0.84 men, 0.95 women); of those diagnosed, proportion on treatment 0.92 (0.90, 0.93); of those receiving treatment, proportion with viral suppression 0.86 (0.81, 0.91). This results in 72% of PLHIV having viral suppression in 2020. We estimated a percentage reduction of 36.5% (13.7% increase to 67.4% reduction) in new infections from 2010 to 2020, and of 30.4% (9.7% increase to 56.6% reduction) in AIDS‐related mortality (UNAIDS target 75%). The modelled absolute rates of HIV incidence and AIDS‐related mortality in 2020 were 5.48 (2.26, 9.24) and 1.93 (1.31, 2.71) per 1000 person‐years respectively. The modelled incidence–mortality ratio and incidence–prevalence ratios in 2020 were 1.05 (0.46, 1.66) and 0.009 (0.004, 0.013) respectively.ConclusionsOur model was able to produce outputs that are simultaneously consistent with an array of observed data and predicted that while the 90‐90‐90 targets are within reach in Zimbabwe, increased efforts are required in diagnosing men in particular. Calculation of the HIV transition metrics suggest increased efforts are needed to bring the HIV epidemic under control.

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Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe

Cited by 23 publications

References 32 publications

Timing of adverse events among voluntary medical male circumcision clients: Implications from routine service delivery in Zimbabwe

Timing of adverse events among voluntary medical male circumcision clients: Implications from routine service delivery in Zimbabwe

Eligibility for hepatitis B antiviral therapy among adults in the general population in Zambia

90‐90‐90 by 2020? Estimation and projection of the adult HIV epidemic and ART programme in Zimbabwe – 2017 to 2020

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