The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa : a retrospective analysis
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Date
Authors
Ngcobo, Sanele
Wolvaardt, Jacqueline Elizabeth (Liz)
Bac, Martin
Webb, Elizabeth M.
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
BACKGROUND : Voluntary medical male circumcision (VMMC) reduces the acquisition of human immunodeficiency
virus (HIV) in heterosexual men by up to 60%. One HIV infection is averted for
every 5 to 15 VMMCs. To conduct VMMCs in large populations, large numbers of trained
healthcare professionals are needed. Countries in Sub-Saharan Africa have a high burden
of HIV and a shortage of healthcare professionals, creating a healthcare conundrum. To
bridge this gap, South Africa launched a new cadre of mid-level medical worker called Clinical
Associates (CA). We assessed the ability of CAs to perform circumcisions of adequate
quality and their subsequent usefulness to meet the demands of VMMCs in a population
with a high HIV burden.
METHODS : We conducted a retrospective analysis, reviewing patient files (n = 4850) of surgical
VMMCs conducted over a 16-month period. Patient files were sourced from clinics and hospitals
that provided free VMMCs in Tshwane district in South Africa.
FINDINGS : Clinical associates performed 88.66% of the circumcisions and doctors performed the
remaining 11.34% (p < 0.001). The number of adverse events did not differ between the two
groups. Data on intra-operative adverse events were available for 4 738 patients. Of these,
341 (7.2%) experienced intra-operative adverse events. For the whole sample, 44 (8.1%, n = 543) adverse events occurred during circumcisions done by doctors and 297 (7.1%, n =
4195) occurred during circumcisions done by CAs (p = 0.385). Clinical associates performed
circumcisions in shorter times (duration: 14.63 minutes) compared to doctors (duration: 15.25 minutes, t = -7.46; p < 0.001). Recorded pain, bleeding, swelling, infection and wound
destruction did not differ between clients circumcised by CAs and doctors. This study is limited
by the use of data from a single district.
CONCLUSIONS : Clinical associates contribute to the demands for high numbers of VMMCs in Tshwane district,
South Africa. Clinical associates perform VMMCs at a clinical standard that is comparable
to circumcisions performed by doctors.
Description
S1 Data.
(XLSX)
Keywords
Voluntary medical male circumcision (VMMC), Clinical Associates (CA), HIV infection, HIV burden, Young adult, Swelling, Surgical infection, South Africa (SA), Human immunodeficiency virus (HIV), Postoperative pain, Population research, Physician, Pathogen load, Operative blood loss, Operation duration, Medical personnel, Male, Adverse outcome, Circumcision
Sustainable Development Goals
Citation
Ngcobo S, Wolvaardt JE, Bac M, Webb E
(2018) The quality of voluntary medical male
circumcision done by mid-level workers in
Tshwane District, South Africa: A retrospective
analysis. PLoS ONE 13(1): e0190795. https://DOI.
org/ 10.1371/journal.pone.0190795.