PMID- 36149904 OWN - NLM STAT- MEDLINE DCOM- 20220928 LR - 20220930 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 17 IP - 9 DP - 2022 TI - Voluntary medical male circumcision in selected provinces in South Africa: Outcomes from a programmatic setting. PG - e0270545 LID - 10.1371/journal.pone.0270545 [doi] LID - e0270545 AB - INTRODUCTION: Voluntary medical male circumcision (VMMC) remains an effective biomedical intervention for HIV prevention in high HIV prevalence countries. In South Africa, United States Agency for International Development VMMC partners provide technical assistance to the Department of Health, at national and provincial levels in support of the establishment of VMMC sites as well as in providing direct VMMC services at site level since April 2012. We describe the outcomes of the Right to Care (RTC) VMMC program implemented in South Africa from 2012 to 2017. METHODS: This retrospective study was undertaken at RTC supported facilities across six provinces. Young males aged >/=10 years who presented at these facilities from 1 July 2012 to 31 September 2017 were included. Outcomes were VMMC uptake, HIV testing uptake and rate of adverse events (AEs). Using a de-identified observational database of these clients, summary statistics of the demographic characteristics and outcomes were calculated. RESULTS: There were a total 1,001,226 attendees of which 998,213 (99.7%) were offered VMMC and had a median age of 15 years (IQR = 12-23 years). Of those offered VMMC, 99.6% (994,293) consented, 96.7% (965,370) were circumcised and the majority (46.3%) were from Gauteng province. HIV testing uptake was 71% with a refusal rate of 15%. Of the newly diagnosed HIV positives, 64% (6,371 / 9,972) referrals were made. The rate of AEs, defined as bleeding, infection, and insufficient skin removal) declined from 3.26% in 2012 to 1.17% in 2017. There was a reduction in infection-related AEs from 2,448 of the 2,602 adverse events (94.08%) in 2012 to 129 of the 2,069 adverse events (6.23%) in 2017. CONCLUSION: There was a high VMMC uptake with a decline in AEs over time. Adolescent men contributed the most to the circumcised population, an indication that the young population accesses medical circumcision more. VMMC programs need to implement innovative demand creation strategies to encourage older males (20-34 years) at higher risk of HIV acquisition to get circumcised for immediate impact in reduction of HIV incidence. HIV prevalence in the total population increased with increasing age, notably in clients above 25 years. FAU - Moyo, Khumbulani AU - Moyo K AD - Right to Care, Johannesburg, South Africa. FAU - Igaba, Nelson AU - Igaba N AD - Right to Care, Johannesburg, South Africa. FAU - Wose Kinge, Constance AU - Wose Kinge C AD - Right to Care, Johannesburg, South Africa. AD - Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. FAU - Chasela, Charles AU - Chasela C AUID- ORCID: 0000-0001-8362-5986 AD - Right to Care, Johannesburg, South Africa. AD - Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. FAU - Phohole, Motshana AU - Phohole M AD - Right to Care, Johannesburg, South Africa. FAU - Grove, Skye AU - Grove S AUID- ORCID: 0000-0002-3792-1685 AD - Right to Care, Johannesburg, South Africa. FAU - Makura, Caroline AU - Makura C AD - Right to Care, Johannesburg, South Africa. FAU - Mudau, Latisani AU - Mudau L AD - Right to Care, Johannesburg, South Africa. FAU - Taljaard, Dirk AU - Taljaard D AD - Centre for HIV and AIDS Prevention Studies (CHAPS), Johannesburg, South Africa. FAU - Rech, Dino AU - Rech D AD - Centre for HIV and AIDS Prevention Studies (CHAPS), Johannesburg, South Africa. FAU - Ramkissoon, Arthi AU - Ramkissoon A AD - Maternal Adolescent and Child Health (MatCH), Durban, South Africa. FAU - Searle, Catherine AU - Searle C AD - Maternal Adolescent and Child Health (MatCH), Durban, South Africa. FAU - Majuba, Pappie AU - Majuba P AD - Right to Care, Johannesburg, South Africa. FAU - Sanne, Ian AU - Sanne I AD - Right to Care, Johannesburg, South Africa. AD - Clinical HIV Research Unit, Department of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. LA - eng PT - Journal Article PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20220923 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adolescent MH - Adult MH - Child MH - *Circumcision, Male MH - *HIV Infections/epidemiology/etiology/prevention & control MH - Humans MH - Male MH - Retrospective Studies MH - South Africa/epidemiology MH - Voluntary Programs MH - Young Adult PMC - PMC9506619 COIS- The authors have declared that no competing interests exist. EDAT- 2022/09/24 06:00 MHDA- 2022/09/28 06:00 PMCR- 2022/09/23 CRDT- 2022/09/23 13:43 PHST- 2021/03/10 00:00 [received] PHST- 2022/06/13 00:00 [accepted] PHST- 2022/09/23 13:43 [entrez] PHST- 2022/09/24 06:00 [pubmed] PHST- 2022/09/28 06:00 [medline] PHST- 2022/09/23 00:00 [pmc-release] AID - PONE-D-21-05600 [pii] AID - 10.1371/journal.pone.0270545 [doi] PST - epublish SO - PLoS One. 2022 Sep 23;17(9):e0270545. doi: 10.1371/journal.pone.0270545. eCollection 2022.