PMID- 25276565
OWN - NLM
STAT- MEDLINE
DCOM- 20150630
LR  - 20211021
IS  - 2169-575X (Print)
IS  - 2169-575X (Electronic)
IS  - 2169-575X (Linking)
VI  - 2
IP  - 1
DP  - 2014 Feb
TI  - Safety of adult medical male circumcision performed by non-physician clinicians 
      in Kenya: a prospective cohort study.
PG  - 93-102
LID - 10.9745/GHSP-D-13-00120 [doi]
AB  - 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.
FAU - Frajzyngier, Vera
AU  - Frajzyngier V
AD  - EngenderHealth , New York, NY , USA.
FAU - Odingo, George
AU  - Odingo G
AD  - EngenderHealth , Nairobi , Kenya.
FAU - Barone, Mark
AU  - Barone M
AD  - EngenderHealth , New York, NY , USA.
FAU - Perchal, Paul
AU  - Perchal P
AD  - EngenderHealth , New York, NY , USA.
FAU - Pavin, Melinda
AU  - Pavin M
AD  - EngenderHealth , New York, NY , USA.
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20140109
PL  - United States
TA  - Glob Health Sci Pract
JT  - Global health, science and practice
JID - 101624414
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - *Allied Health Personnel
MH  - Circumcision, Male/*adverse effects
MH  - *Clinical Competence
MH  - Humans
MH  - Kenya
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Patient Satisfaction
MH  - Prospective Studies
MH  - Risk Factors
MH  - *Safety
MH  - Surveys and Questionnaires
MH  - Young Adult
PMC - PMC4168600
COIS- Competing Interests: None declared.
EDAT- 2014/10/03 06:00
MHDA- 2014/10/03 06:01
PMCR- 2014/01/09
CRDT- 2014/10/03 06:00
PHST- 2013/08/09 00:00 [received]
PHST- 2013/11/10 00:00 [accepted]
PHST- 2014/10/03 06:00 [entrez]
PHST- 2014/10/03 06:00 [pubmed]
PHST- 2014/10/03 06:01 [medline]
PHST- 2014/01/09 00:00 [pmc-release]
AID - GHSP-D-13-00120 [pii]
AID - 10.9745/GHSP-D-13-00120 [doi]
PST - epublish
SO  - Glob Health Sci Pract. 2014 Jan 9;2(1):93-102. doi: 10.9745/GHSP-D-13-00120. 
      eCollection 2014 Feb.