PMID- 37773121 OWN - NLM STAT- MEDLINE DCOM- 20231005 LR - 20231122 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 23 IP - 1 DP - 2023 Sep 29 TI - Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis. PG - 1044 LID - 10.1186/s12913-023-10016-6 [doi] LID - 1044 AB - BACKGROUND: Surgical voluntary medical male circumcision (VMMC) is a safe procedure; however, maintaining quality standards at scale, particularly during scale-up, is a challenge making ongoing quality management (QM) efforts essential. This study describes program quality measured by rates of adverse events (AEs) over four years of VMMC implementation in Namibia, compares AE rates over time, and discusses QM processes that contextualize AE trends and illustrate improvements in quality as the program matured. The International Training and Education Center for Health (I-TECH) assisted the Namibian Ministry of Health and Social Services (MoHSS) in expanding VMMC in three regions among boys and men over 10 years of age between January 2015 and September 2019. METHODS: A comprehensive package of QM strategies was implemented by multi-disciplinary onsite teams with support from national and international technical advisors. Retrospective routine MoHSS data from the VMMC register, client forms, and monthly AE reports were collected during implementation in the three regions to assess the impact of QM interventions on AEs and to calculate the proportion of clients who experienced AEs over time. The proportion of clients who experienced an AE over time was compared using a Cochran-Armitage test for trend. RESULTS: Between January 2015 and September 2019, 40,336 clients underwent VMMC and 593 (1.5%) clients experienced a post-operative AE in the three supported regions. The AE rate was highest in the first quarter of clinical service delivery in each region (January-March 2015 in Oshana and Zambezi, October-December 2017 in //Kharas) but declined over the implementation period as the program matured. This observed trend between program maturity and declining AE rates over time was significant (p < 0.001) when compared using a Cochran-Armitage test for trend. CONCLUSIONS: As the I-TECH-supported VMMC program matured, QM measures were introduced and routinized, and clinical quality improved over time with the rate of AEs decreasing significantly over the implementation period. Applying systematic and continuous QM processes and approaches across the continuum of VMMC services and considering local context can contribute to increased clinical safety. QM measures that are established in more mature program sites can be quickly adopted to respond to quality issues in program expansion sites. CI - (c) 2023. BioMed Central Ltd., part of Springer Nature. FAU - O'Bryan, Gillian AU - O'Bryan G AD - International Training and Education Center for Health (I-TECH), Seattle, WA, USA. gilliano@uw.edu. AD - Department of Global Health, University of Washington, Seattle, WA, USA. gilliano@uw.edu. FAU - Ensminger, Alison AU - Ensminger A AD - International Training and Education Center for Health (I-TECH), Seattle, WA, USA. AD - Department of Global Health, University of Washington, Seattle, WA, USA. FAU - Billah, Idel AU - Billah I AD - International Training and Education Center for Health (I-TECH), Windhoek, Namibia. FAU - Sithole, Edwin AU - Sithole E AD - Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia. FAU - Nghatanga, Magdaleena AU - Nghatanga M AD - International Training and Education Center for Health (I-TECH), Windhoek, Namibia. FAU - Brandt, Laura AU - Brandt L AD - Department of Global Health, University of Washington, Seattle, WA, USA. AD - International Training and Education Center for Health (I-TECH), Windhoek, Namibia. FAU - Shepard, Mark AU - Shepard M AD - Department of Global Health, University of Washington, Seattle, WA, USA. AD - International Training and Education Center for Health (I-TECH), Windhoek, Namibia. FAU - Aupokolo, Mekondjo AU - Aupokolo M AD - Directorate of Special Programmes-Ministry of Health and Social Services, Windhoek, Namibia. FAU - Mengistu, Assegid Tassew AU - Mengistu AT AD - Directorate of Special Programmes-Ministry of Health and Social Services, Windhoek, Namibia. FAU - Forster, Norbert AU - Forster N AD - Department of Global Health, University of Washington, Seattle, WA, USA. AD - International Training and Education Center for Health (I-TECH), Windhoek, Namibia. FAU - Zemburuka, Brigitte AU - Zemburuka B AD - Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia. FAU - Mutandi, Gram AU - Mutandi G AD - Centers for Disease Control and Prevention (CDC/DDPHSIS/CGH/DGHT), Windhoek, Namibia. FAU - Barnhart, Scott AU - Barnhart S AD - International Training and Education Center for Health (I-TECH), Seattle, WA, USA. AD - Department of Medicine, University of Washington, Seattle, WA, USA. FAU - O'Malley, Gabrielle AU - O'Malley G AD - International Training and Education Center for Health (I-TECH), Seattle, WA, USA. AD - Department of Global Health, University of Washington, Seattle, WA, USA. FAU - Feldacker, Caryl AU - Feldacker C AD - International Training and Education Center for Health (I-TECH), Seattle, WA, USA. AD - Department of Global Health, University of Washington, Seattle, WA, USA. LA - eng GR - NU2GGH001430/CC/CDC HHS/United States PT - Journal Article DEP - 20230929 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 SB - IM MH - Humans MH - Male MH - *Circumcision, Male/adverse effects MH - Retrospective Studies MH - Namibia MH - Voluntary Programs MH - Program Development MH - *HIV Infections PMC - PMC10543846 OTO - NOTNLM OT - Adverse events OT - HIV prevention OT - Namibia OT - Quality OT - Voluntary Medical Male Circumcision (VMMC) COIS- The authors declare no competing interests. EDAT- 2023/09/29 12:44 MHDA- 2023/10/05 06:43 PMCR- 2023/09/29 CRDT- 2023/09/29 11:51 PHST- 2023/02/28 00:00 [received] PHST- 2023/09/11 00:00 [accepted] PHST- 2023/10/05 06:43 [medline] PHST- 2023/09/29 12:44 [pubmed] PHST- 2023/09/29 11:51 [entrez] PHST- 2023/09/29 00:00 [pmc-release] AID - 10.1186/s12913-023-10016-6 [pii] AID - 10016 [pii] AID - 10.1186/s12913-023-10016-6 [doi] PST - epublish SO - BMC Health Serv Res. 2023 Sep 29;23(1):1044. doi: 10.1186/s12913-023-10016-6.