The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis.
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. Countr...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC5774685?pdf=render |
| _version_ | 1828761278609358848 |
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| author | Sanele Ngcobo Jacqueline Elizabeth Wolvaardt Martin Bac Elize Webb |
| author_facet | Sanele Ngcobo Jacqueline Elizabeth Wolvaardt Martin Bac Elize Webb |
| author_sort | Sanele Ngcobo |
| collection | DOAJ |
| description | 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.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.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.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. |
| first_indexed | 2024-12-11T01:27:22Z |
| format | Article |
| id | doaj.art-3f64496500b04f9ba3ef8890d8d011b1 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-11T01:27:22Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-3f64496500b04f9ba3ef8890d8d011b12022-12-22T01:25:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01131e019079510.1371/journal.pone.0190795The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis.Sanele NgcoboJacqueline Elizabeth WolvaardtMartin BacElize WebbVoluntary 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.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.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.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.http://europepmc.org/articles/PMC5774685?pdf=render |
| spellingShingle | Sanele Ngcobo Jacqueline Elizabeth Wolvaardt Martin Bac Elize Webb The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. PLoS ONE |
| title | The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. |
| title_full | The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. |
| title_fullStr | The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. |
| title_full_unstemmed | The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. |
| title_short | The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis. |
| title_sort | quality of voluntary medical male circumcision done by mid level workers in tshwane district south africa a retrospective analysis |
| url | http://europepmc.org/articles/PMC5774685?pdf=render |
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