PrePex male circumcision: follow-up and outcomes during the first two years of implementation at the Rwanda Military Hospital
PrePex male circumcision: follow-up and outcomes during the first two years of implementation at the Rwanda Military Hospital
BACKGROUND:
PrePex Male Circumcision (MC) has been demonstrated as an effective and scalable strategy to prevent HIV infection in low- and middle-income countries. This study describes the follow-up and outcomes of clients who underwent PrePex MC between January 2011 and December 2012 with weekly follow-up at the Rwanda Military Hospital, the first national hospital in Rwanda to adopt PrePex.
METHODS:
Data on 570 clients age 21 to 54 were extracted from patient records. We compared socio-demographic and clinical characteristics, the operator's qualification, HIV status, pain before and after device removal, urological status, device size and follow-up time between clients who were formally discharged and those who defaulted. We reported bivariate associations between each covariate and discharge status, number of people with adverse events by discharge status, and time to formal discharge or defaulting using life table methods. Data were entered into Epidata and analyzed with Stata v 13.
RESULTS:
Among study participants, 96.5% were circumcised by non-physician operators, 85.4%were under 30 years, 98.9% were HIV-negative and 97.9% were without any urological problems that could delay the healing time. Most (70.7%) defaulted before formal discharge. Pain before (p<0.001) and after PrePex device removal (p = 0.001) were associated with discharge status, although very few cases were reported, and pain was more commonly missing among defaulters. Twenty-seven adverse events were reported (7 formally discharged, 20 defaulters). Median follow-up time was seven weeks among formally discharged and six weeks among defaulters (p<0.001).
CONCLUSION:
Given that all socio-demographic and most clinical characteristics were not associated with defaulting, we hypothesize that clients stopped returning once they determined they were healed. We recommend less frequent follow-up protocols to encourage clinical visits until formal discharge. Based on these results and recommendations, we believe PrePex MC is a practical circumcision strategy in Rwanda and in sub-Saharan Africa.
e0138287
Ndagijimana, Albert
3be87f21-4617-4a1b-ad0b-c1298e10eb43
Mugenzi, Pacifique
3a991df6-990b-4fc0-bce5-ef1b20205b40
Thomson, Dana R.
c6aa22a0-9ee2-4d86-9bd4-b3a8487eb15b
Hedt-Gauthier, Bethany
899e51e6-e74c-433d-bc11-eea4928f8d5e
Condo, Jeanine U.
18cf0c98-72e6-40ea-9450-68b9d498a4da
Ngoga, Eugene
264e38a3-037e-4e36-8af2-fce819006f22
Dezzutti, Charlene S.
9d9bc0e1-cb38-47aa-bfc1-f1deb46d36aa
23 September 2015
Ndagijimana, Albert
3be87f21-4617-4a1b-ad0b-c1298e10eb43
Mugenzi, Pacifique
3a991df6-990b-4fc0-bce5-ef1b20205b40
Thomson, Dana R.
c6aa22a0-9ee2-4d86-9bd4-b3a8487eb15b
Hedt-Gauthier, Bethany
899e51e6-e74c-433d-bc11-eea4928f8d5e
Condo, Jeanine U.
18cf0c98-72e6-40ea-9450-68b9d498a4da
Ngoga, Eugene
264e38a3-037e-4e36-8af2-fce819006f22
Dezzutti, Charlene S.
9d9bc0e1-cb38-47aa-bfc1-f1deb46d36aa
Ndagijimana, Albert, Mugenzi, Pacifique and Thomson, Dana R. et al.
,
Dezzutti, Charlene S.
(ed.)
(2015)
PrePex male circumcision: follow-up and outcomes during the first two years of implementation at the Rwanda Military Hospital.
PLoS ONE, 10 (9), .
(doi:10.1371/journal.pone.0138287).
(PMID:26398343)
Abstract
BACKGROUND:
PrePex Male Circumcision (MC) has been demonstrated as an effective and scalable strategy to prevent HIV infection in low- and middle-income countries. This study describes the follow-up and outcomes of clients who underwent PrePex MC between January 2011 and December 2012 with weekly follow-up at the Rwanda Military Hospital, the first national hospital in Rwanda to adopt PrePex.
METHODS:
Data on 570 clients age 21 to 54 were extracted from patient records. We compared socio-demographic and clinical characteristics, the operator's qualification, HIV status, pain before and after device removal, urological status, device size and follow-up time between clients who were formally discharged and those who defaulted. We reported bivariate associations between each covariate and discharge status, number of people with adverse events by discharge status, and time to formal discharge or defaulting using life table methods. Data were entered into Epidata and analyzed with Stata v 13.
RESULTS:
Among study participants, 96.5% were circumcised by non-physician operators, 85.4%were under 30 years, 98.9% were HIV-negative and 97.9% were without any urological problems that could delay the healing time. Most (70.7%) defaulted before formal discharge. Pain before (p<0.001) and after PrePex device removal (p = 0.001) were associated with discharge status, although very few cases were reported, and pain was more commonly missing among defaulters. Twenty-seven adverse events were reported (7 formally discharged, 20 defaulters). Median follow-up time was seven weeks among formally discharged and six weeks among defaulters (p<0.001).
CONCLUSION:
Given that all socio-demographic and most clinical characteristics were not associated with defaulting, we hypothesize that clients stopped returning once they determined they were healed. We recommend less frequent follow-up protocols to encourage clinical visits until formal discharge. Based on these results and recommendations, we believe PrePex MC is a practical circumcision strategy in Rwanda and in sub-Saharan Africa.
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Accepted/In Press date: 28 August 2015
Published date: 23 September 2015
Organisations:
Social Statistics & Demography
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Local EPrints ID: 404197
URI: http://eprints.soton.ac.uk/id/eprint/404197
ISSN: 1932-6203
PURE UUID: f18e1ddd-ce8e-4114-bcfd-c2bb8b872b7e
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Date deposited: 03 Jan 2017 15:07
Last modified: 15 Mar 2024 04:01
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Contributors
Author:
Albert Ndagijimana
Author:
Pacifique Mugenzi
Author:
Dana R. Thomson
Author:
Bethany Hedt-Gauthier
Author:
Jeanine U. Condo
Author:
Eugene Ngoga
Editor:
Charlene S. Dezzutti
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