PMID- 34173789
OWN - NLM
STAT- MEDLINE
DCOM- 20211230
LR  - 20230927
IS  - 1944-7884 (Electronic)
IS  - 1525-4135 (Print)
IS  - 1525-4135 (Linking)
VI  - 88
IP  - 2
DP  - 2021 Oct 1
TI  - Adverse Event Trends Within a Large-Scale, Routine, Voluntary Medical Male 
      Circumcision Program in Zimbabwe, 2014-2019.
PG  - 173-180
LID - 10.1097/QAI.0000000000002751 [doi]
AB  - BACKGROUND: Between 2008 and 2020, over 22.6 million male circumcisions (MCs) 
      were performed among men >/=10 years in 15 priority countries of East and Southern 
      Africa. Few studies from routine MC programs operating at scale describe trends 
      of adverse events (AEs) or AE rates over time. SETTING: Routine program data from 
      a large MC program in Zimbabwe. METHODS: chi2 compared characteristics of patients 
      with AEs. Univariable and multivariable logistic models examined factors 
      associated with AE severity. Cochran-Armitage trend tests compared AE rate trends 
      by year (2014-2019), age, and MC method (2017-2019). RESULTS: From 2014 to 2019, 
      469,000 men were circumcised; of the total men circumcised, 38%, 27%, and 35% 
      were conducted among individuals aged 10-14; 15-19; and >/=20 years, respectively. 
      Most MCs (95%) used surgical (dorsal slit or forceps-guided) methods; 5% were 
      device based (PrePex). AEs were reported among 632 (0.13%) MCs; 0.05% were 
      severe. From 2015 to 2019, overall AE rates declined from 34/10,000 to 5/10,000 
      (P-value <0.001). Severe AE rates also decreased over this period from 12/10,000 
      to 2/10,000 (P-value <0.001). AE rates among younger clients, aged 10-14 
      (18/10,000) were higher than among older age men (9/10,000) aged >/=20 years (P < 
      0.001); however, there was no significant association between age and AE 
      severity. CONCLUSION: AE rates each year and over time were lower than the World 
      Health Organization acceptable maximum (2% AEs). ZAZIC quality assurance 
      activities ensured guideline adherence, mentored clinicians to MC competency, 
      promoted quality client education and counseling, and improved AE reporting over 
      time. Decreases in AE rates are likely attributed to safety gains and increasing 
      provider experience.
CI  - Copyright (c) 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Victor, Omollo
AU  - Victor O
AD  - Department of Global Health, University of Washington, Seattle, WA.
FAU - Phiona, Marongwe
AU  - Phiona M
AD  - Zimbabwe Technical Training and Education Center for Health (ZIMTTECH), Harare, 
      Zimbabwe.
FAU - Vernon, Murenje
AU  - Vernon M
AD  - Zimbabwe Technical Training and Education Center for Health (ZIMTTECH), Harare, 
      Zimbabwe.
FAU - Thoko, Madoda
AU  - Thoko M
AD  - Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe.
FAU - Paidamoyo, Gonouya
AU  - Paidamoyo G
AD  - Zimbabwe Technical Training and Education Center for Health (ZIMTTECH), Harare, 
      Zimbabwe.
FAU - Farai, Gwenzi
AU  - Farai G
AD  - Zimbabwe Technical Training and Education Center for Health (ZIMTTECH), Harare, 
      Zimbabwe.
FAU - Joseph, Hove
AU  - Joseph H
AD  - Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe.
FAU - Munyaradzi, Tinashe
AU  - Munyaradzi T
AD  - Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe.
FAU - Olbarn, Rutsito
AU  - Olbarn R
AD  - Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe.
FAU - Pesanai, Chatikobo
AU  - Pesanai C
AD  - Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe.
FAU - Mufuta, Tshimanga
AU  - Mufuta T
AD  - Zimbabwe Community Health Intervention Project (ZiCHIRe), Harare, Zimbabwe.
FAU - Vuyelwa, Sidile-Chitimbire
AU  - Vuyelwa SC
AD  - Zimbabwe Association of Church-related Hospitals (ZACH), Harare, Zimbabwe.
FAU - Sinokuthemba, Xaba
AU  - Sinokuthemba X
AD  - Ministry of Health and Child Care, Harare Zimbabwe.
FAU - Batsirai, Makunike-Chikwinya
AU  - Batsirai MC
AD  - Zimbabwe Technical Training and Education Center for Health (ZIMTTECH), Harare, 
      Zimbabwe.
FAU - Marrianne, Holec
AU  - Marrianne H
AD  - Department of Global Health, International Training and Education Center for 
      Health (I-TECH), University of Washington, Seattle, WA; and.
FAU - Scott, Barnhart
AU  - Scott B
AD  - Department of Global Health, University of Washington, Seattle, WA.
AD  - Department of Global Health, International Training and Education Center for 
      Health (I-TECH), University of Washington, Seattle, WA; and.
AD  - Department of Medicine, University of Washington, Seattle, WA.
FAU - Feldacker, Caryl
AU  - Feldacker C
AD  - Department of Global Health, University of Washington, Seattle, WA.
AD  - Department of Global Health, International Training and Education Center for 
      Health (I-TECH), University of Washington, Seattle, WA; and.
LA  - eng
GR  - U2G GH000972/GH/CGH CDC HHS/United States
GR  - PEPFAR/PEPFAR/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - J Acquir Immune Defic Syndr
JT  - Journal of acquired immune deficiency syndromes (1999)
JID - 100892005
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Circumcision, Male/*adverse effects
MH  - HIV Infections/epidemiology/*prevention & control
MH  - Humans
MH  - Logistic Models
MH  - Male
MH  - Program Evaluation
MH  - *Quality of Health Care
MH  - Voluntary Programs
MH  - Young Adult
MH  - Zimbabwe/epidemiology
PMC - PMC8434989
MID - NIHMS1715740
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2021/06/27 06:00
MHDA- 2021/12/31 06:00
PMCR- 2022/10/01
CRDT- 2021/06/26 12:05
PHST- 2020/10/04 00:00 [received]
PHST- 2021/05/20 00:00 [accepted]
PHST- 2021/06/27 06:00 [pubmed]
PHST- 2021/12/31 06:00 [medline]
PHST- 2021/06/26 12:05 [entrez]
PHST- 2022/10/01 00:00 [pmc-release]
AID - 00126334-202110010-00008 [pii]
AID - 10.1097/QAI.0000000000002751 [doi]
PST - ppublish
SO  - J Acquir Immune Defic Syndr. 2021 Oct 1;88(2):173-180. doi: 
      10.1097/QAI.0000000000002751.