PMID- 28880904 OWN - NLM STAT- MEDLINE DCOM- 20171016 LR - 20191218 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 12 IP - 9 DP - 2017 TI - Prospective comparison of two models of integrating early infant male circumcision with maternal child health services in Kenya: The Mtoto Msafi Mbili Study. PG - e0184170 LID - 10.1371/journal.pone.0184170 [doi] LID - e0184170 AB - As countries scale up adult voluntary medical male circumcision (VMMC) for HIV prevention, they are looking ahead to long term sustainable strategies, including introduction of early infant male circumcision (EIMC). To address the lack of evidence regarding introduction of EIMC services in sub-Saharan African settings, we conducted a simultaneous, prospective comparison of two models of EIMC service delivery in Homa Bay County, Kenya. In one division a standard delivery package (SDP) was introduced and included health facility-based provision of EIMC services with community engagement for client referral versus in a different division a standard package plus (SDPplus) that included community-delivered EIMC services. Babies 1-60 days old were eligible for EIMC. A representative sample of mothers and fathers of baby boys at 16 health facilities was surveyed. We examined differences between mothers and fathers in the SDP and SDPplus divisions and identified factors associated with EIMC uptake. We report adjusted prevalence ratios (aPR). Of 1660 mothers interviewed, 1501 (89%) gave approval to contact the father, and 1259 fathers (84%) were interviewed. The proportion of babies circumcised was slightly greater in the SDPplus division than the SDP division (27.3% vs 23.7%), but the difference was not significant (p = 0.08). In adjusted analyses, however, the prevalence of babies being circumcised was greater in the SDPplus division (aPR = 1.23, 95% CI:1.04-1.45) and the factors associated with a baby being circumcised were the mother having received information about EIMC (during pregnancy, aPR = 4.81, 95% CI: 2.21-3.42), having discussed circumcision with the father if married or cohabiting (aPR = 5.39, 95% CI: 3.31-8.80) or being single (aPR = 5.67, 95% CI: 3.31-9.69), perceiving herself to be living with HIV (aPR = 1.39, 95% CI: 1.15-1.67), or having a post-secondary education (aPR = 1.33, 95% CI: 1.04-1.69), and the father being Muslim (aPR = 1.85, 95% CI: 1.29-2.65) or circumcised (aPR = 1.34, 95% CI: 1.13-1.59). The median age of 2117 babies circumcised was 8 days (IQR: 1-36), and the median weight was 3.6 kg (IQR: 3.2-4.4). There were 6 moderate adverse events (AEs) (0.28%); 5 severe AEs (0.24%), all involving an injury to the glans penis, requiring hospitalization and corrective surgery; and one death probably related to the procedure. There were no AEs among the 365 procedures performed outside health facilities. Information and education campaigns must reach members of the general population, especially men and fathers, who are influential to the EIMC decision. Serious AEs using the Mogen clamp are rare, but do occur and require efficient, reliable emergency back-up. Our results can assist countries considering scale-up of EIMC services for HIV prevention as their adult VMMC programs mature. FAU - Bailey, Robert C AU - Bailey RC AUID- ORCID: 0000-0002-9202-1794 AD - Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America. FAU - Adera, Fredrick AU - Adera F AD - Nyanza Reproductive Health Society, Kisumu, Kenya. FAU - Mackesy-Amiti, Mary Ellen AU - Mackesy-Amiti ME AD - Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America. FAU - Adipo, Timothy AU - Adipo T AD - Nyanza Reproductive Health Society, Kisumu, Kenya. FAU - Nordstrom, Sherry K AU - Nordstrom SK AD - Advocate Medical Group, Advocate Christ Medical Center, Oak Lawn, IL, United States of America. FAU - Mehta, Supriya D AU - Mehta SD AD - Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America. FAU - Jaoko, Walter AU - Jaoko W AD - Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. FAU - Langi, F L Fredrik G AU - Langi FLFG AD - Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America. FAU - Obiero, Walter AU - Obiero W AD - Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America. FAU - Obat, Edmon AU - Obat E AD - Nyanza Reproductive Health Society, Kisumu, Kenya. FAU - Otieno, Fredrick O AU - Otieno FO AD - Nyanza Reproductive Health Society, Kisumu, Kenya. FAU - Young, Marisa R AU - Young MR AD - Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, United States of America. LA - eng GR - R01 AI108371/AI/NIAID NIH HHS/United States GR - U01 AI099953/AI/NIAID NIH HHS/United States PT - Comparative Study PT - Journal Article DEP - 20170907 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adult MH - *Circumcision, Male MH - Fathers MH - Humans MH - Infant MH - Infant, Newborn MH - Kenya MH - Male MH - *Maternal-Child Health Services MH - *Models, Theoretical MH - Mothers MH - Multivariate Analysis MH - Prospective Studies PMC - PMC5589171 COIS- Competing Interests: The authors have declared that no competing interests exist. EDAT- 2017/09/08 06:00 MHDA- 2017/10/17 06:00 PMCR- 2017/09/07 CRDT- 2017/09/08 06:00 PHST- 2017/03/29 00:00 [received] PHST- 2017/08/18 00:00 [accepted] PHST- 2017/09/08 06:00 [entrez] PHST- 2017/09/08 06:00 [pubmed] PHST- 2017/10/17 06:00 [medline] PHST- 2017/09/07 00:00 [pmc-release] AID - PONE-D-17-12170 [pii] AID - 10.1371/journal.pone.0184170 [doi] PST - epublish SO - PLoS One. 2017 Sep 7;12(9):e0184170. doi: 10.1371/journal.pone.0184170. eCollection 2017.