Uptake and outcomes of early infant male circumcision services in four counties in Western Kenya

Abstract

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%.
 Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised.
 Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program.
 Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%.
 Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable.
 Keywords: Adverse event; circumcision; early male infant; uptake; western Kenya.

Non-therapeutic male circumcision in infancy or childhood and risk of human immunodeficiency virus and other sexually transmitted infections: national cohort study in Denmark

“…In contrast to findings from African RCTs of circumcisions carried out in adolescence and adulthood, which together suggested 58% efficacy of VMMC in providing short and intermediate term prevention of HIV [2][3][4][5], our national cohort study with up to more than three decades of follow-up found no reduction in risk of HIV or other STIs following circumcision in infancy or childhood. Consequently, our findings question the relevance and justifiability of ongoing efforts to expand VMMC programs in Africa to also cover circumcision of male infants and boys under 15 years of age [22][23][24][25]. If childhood circumcision provides no protection against the acquisition of HIV and other STIs in adulthood, as our findings and those of the Dunedin cohort study suggest [34], this knowledge should inform debates over the practice of non-therapeutic circumcision of male minors [35][36][37][38][39].…”

“…Such an approach was appropriate because the average periods of follow-up were almost identical in the compared groups, being 21.8 years among intact males and 21.6 years among circumcised males. Among international organizations and stakeholders arguing in favor of circumcision in the fight against HIV in Africa, the expectation is that infant or childhood circumcision will provide the same, or an even higher, degree of HIV protection compared to what has been reported for adult male circumcision [14,[22][23][24][25]. Consequently, we tested the directional (one-sided) null hypothesis of equal or higher rates of HIV acquisition in circumcised males against the alternative hypothesis that the rate is lower among circumcised males.…”

“…Despite this limitation, our study had sufficient statistical power to show with 95% confidence that the true circumcision-associated HRs for any STI, anogenital warts and syphilis are at least 24%, 20% and 23% elevated, respectively. Moreover, in a directional (one-sided) test favoring circumcised genitalia, a test situation dictated by the prevailing expectation among organizations and stakeholders promoting circumcision in Africa that rates of HIV will be lower among circumcised males [14,[22][23][24][25], we failed to identify a difference in HIV risk between intact and circumcised males.…”

“…Given that men in many target regions are not volunteering for circumcision at the rates set by official quotas [21], attempts have been made to increase parental acceptability of early infant male circumcision in high-risk settings [22][23][24], so far with limited success [25]. However, no RCT or carefully conducted observational study with long-term follow-up has ever demonstrated an HIV-protective effect of circumcision performed in infancy or childhood.…”