PMID- 32334596
OWN - NLM
STAT- MEDLINE
DCOM- 20210304
LR  - 20210304
IS  - 1471-2490 (Electronic)
IS  - 1471-2490 (Linking)
VI  - 20
IP  - 1
DP  - 2020 Apr 25
TI  - Case series of glans injuries during voluntary medical male circumcision for HIV 
      prevention - eastern and southern Africa, 2015-2018.
PG  - 45
LID - 10.1186/s12894-020-00613-6 [doi]
LID - 45
AB  - BACKGROUND: Male circumcision confers partial protection against heterosexual HIV 
      acquisition among men. The President's Emergency Plan for AIDS Relief (PEPFAR) 
      has supported > 18,900,000 voluntary medical male circumcisions (VMMC). Glans 
      injuries (GIs) are rare but devastating adverse events (AEs) that can occur 
      during circumcision. To address this issue, PEPFAR has supported multiple 
      interventions in the areas of surveillance, policy, education, training, supply 
      chain, and AE management. METHODS: Since 2015, PEPFAR has conducted surveillance 
      of GIs including rapid investigation by the in-country PEPFAR team. This 
      information is collected on standardized forms, which were reviewed for this 
      analysis. RESULTS: Thirty-six GIs were reported from 2015 to 2018; all patients 
      were < 15 years old (~ 0.7 per 100,000 VMMCs in this age group) with a decreasing 
      annual rate (2015: 0.7 per 100,000 VMMCs; 2018: 0.4 per 100,000 VMMC; p = 0.02). 
      Most (64%) GIs were partial or complete amputations. All amputations among 
      10-14 year-olds occurred using the forceps-guided (FG) method, as opposed to the 
      dorsal-slit (DS) method, and three GIs among infants occurred using a Mogen 
      clamp. Of 19 attempted amputation repairs, reattached tissue was viable in four 
      (21%) in the short term. In some cases, inadequate DS method training and being 
      overworked, were found. CONCLUSION: Following numerous interventions by PEPFAR 
      and other stakeholders, GIs are decreasing; however, they have not been 
      eliminated and remain a challenge for the VMMC program. Preventing further cases 
      of complete and partial amputation will likely require additional interventions 
      that prevent use of the FG method in young patients and the Mogen clamp in 
      infants. Improving management of GIs is critical to optimizing outcomes.
FAU - Lucas, Todd J
AU  - Lucas TJ
AD  - Epidemic Intelligence Service, Centers for Disease Control and Prevention, 
      Atlanta, GA, USA. tlucas@cdc.gov.
AD  - Division of Healthcare Quality Promotion, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA. tlucas@cdc.gov.
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA. tlucas@cdc.gov.
FAU - Toledo, Carlos
AU  - Toledo C
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA.
FAU - Davis, Stephanie M
AU  - Davis SM
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA.
FAU - Watts, D Heather
AU  - Watts DH
AD  - U.S. Office of the Global HIV/AIDS Coordinator, Washington, D.C, USA.
FAU - Cavanaugh, Joseph S
AU  - Cavanaugh JS
AD  - U.S. Office of the Global HIV/AIDS Coordinator, Washington, D.C, USA.
FAU - Kiggundu, Valerian
AU  - Kiggundu V
AD  - Office of HIV/AIDS, U.S. Agency for International Development, Washington, D.C, 
      USA.
FAU - Thomas, Anne G
AU  - Thomas AG
AD  - Defense Health Agency, Department of Defense, San Diego, CA, USA.
FAU - Odoyo-June, Elijah
AU  - Odoyo-June E
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Nairobi, Kenya.
FAU - Bonnecwe, Collen
AU  - Bonnecwe C
AD  - National Department of Health, Pretoria, South Africa.
FAU - Maringa, Tintswalo Hilda
AU  - Maringa TH
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Pretoria, South Africa.
FAU - Martin, Enilda
AU  - Martin E
AD  - U.S. Agency for International Development, Pretoria, South Africa.
FAU - Juma, Ambrose Wanyonyi
AU  - Juma AW
AD  - National AIDS and STI Control Program, Ministry of Health, Nairobi, Kenya.
FAU - Xaba, Sinokuthemba
AU  - Xaba S
AD  - Ministry of Health and Child Care, Harare, Zimbabwe.
FAU - Balachandra, Shirish
AU  - Balachandra S
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Harare, Zimbabwe.
FAU - Come, Jotamo
AU  - Come J
AD  - Ministry of Health, Maputo, Mozambique.
FAU - Canda, Marcos
AU  - Canda M
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Maputo, Mozambique.
FAU - Nyirenda, Rose
AU  - Nyirenda R
AD  - Ministry of Health, Lilongwe, Malawi.
FAU - Msungama, Wezi
AU  - Msungama W
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Lilongwe, Malawi.
FAU - Odek, James
AU  - Odek J
AD  - U.S. Agency for International Development, Lilongwe, Malawi.
FAU - Lija, Gissenge J I
AU  - Lija GJI
AD  - National AIDS Control Program, Ministry of Health, Community Development, Gender, 
      Elderly and Children, Dar es Salaam, Tanzania.
FAU - Mlanga, Erick
AU  - Mlanga E
AD  - U.S. Agency for International Development, Dar es Salaam, Tanzania.
FAU - Zulu, James Exnobert
AU  - Zulu JE
AD  - Ministry of Health, Lusaka, Zambia.
FAU - O'Bra, Heidi
AU  - O'Bra H
AD  - U.S. Agency for International Development, Lusaka, Zambia.
FAU - Chituwo, Omega
AU  - Chituwo O
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Lusaka, Zambia.
FAU - Aupokolo, Mekondjo
AU  - Aupokolo M
AD  - Ministry of Health and Social Services, Windhoek, Namibia.
FAU - Mali, Denis A
AU  - Mali DA
AD  - U.S. Agency for International Development, Windhoek, Namibia.
FAU - Zemburuka, Brigitte
AU  - Zemburuka B
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Windhoek, Namibia.
FAU - Malaba, Kananga Dany
AU  - Malaba KD
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Gaborone, Botswana.
FAU - Ntsuape, Onkemetse Conrad
AU  - Ntsuape OC
AD  - Ministry of Health and Wellness, Gaborone, Botswana.
FAU - Hines, Jonas Z
AU  - Hines JZ
AD  - Division of Global HIV and Tuberculosis, Centers for Disease Control and 
      Prevention, Atlanta, GA, USA.
LA  - eng
PT  - Journal Article
DEP - 20200425
PL  - England
TA  - BMC Urol
JT  - BMC urology
JID - 100968571
SB  - IM
MH  - Adolescent
MH  - Africa, Eastern
MH  - Africa, Southern
MH  - Child
MH  - Child, Preschool
MH  - Circumcision, Male/*adverse effects
MH  - HIV Infections/*prevention & control
MH  - Humans
MH  - Infant
MH  - Intraoperative Complications/*etiology
MH  - Male
MH  - Penis/*injuries
PMC - PMC7183662
OTO - NOTNLM
OT  - Amputation
OT  - HIV
OT  - Intraoperative complications
OT  - Male circumcision
COIS- The authors declare that they have no competing interests.
EDAT- 2020/04/27 06:00
MHDA- 2021/03/05 06:00
PMCR- 2020/04/25
CRDT- 2020/04/27 06:00
PHST- 2019/11/06 00:00 [received]
PHST- 2020/04/08 00:00 [accepted]
PHST- 2020/04/27 06:00 [entrez]
PHST- 2020/04/27 06:00 [pubmed]
PHST- 2021/03/05 06:00 [medline]
PHST- 2020/04/25 00:00 [pmc-release]
AID - 10.1186/s12894-020-00613-6 [pii]
AID - 613 [pii]
AID - 10.1186/s12894-020-00613-6 [doi]
PST - epublish
SO  - BMC Urol. 2020 Apr 25;20(1):45. doi: 10.1186/s12894-020-00613-6.