Outcomes of voluntary medical male circumcision performed by medical doctors and non-doctor health workers in central Uganda

Hope Kibansha Matumaini,Anthony Batte,Sam Luboga,Kennedy Otwombe,Emily Lebotsa

doi:10.1186/s12301-021-00156-8

Abstract

BackgroundVoluntary medical male circumcision (VMMC) reduces the risk of HIV transmission. Task shifting of VMMCs to non-doctor health workers is recommended to enhance scale-up of VMMC programs. This study evaluated outcomes of circumcision conducted by doctors compared to non-doctors in central Uganda.MethodsIn this prospective observational study, we observed and followed 274 males at 3 health facilities in Kampala, Uganda. Each participant was observed during the circumcision procedure, monitored for 2 h post-surgery and assessed at 24 h, 3 days and after one week for adverse events.ResultsThe median age of the circumcised men was 24.00(IQR, 20.00–28.00) years. Of the VMMCs, 19.3% (53/274) were carried out by doctors while 80.7% (221/274) by non-doctors. Following VMMC, 5.47% (15/274) men experienced adverse events and proportions of adverse events by cadre were similar; doctors (5.66% [3/53]) and non-doctor health workers (5.43% [12/221]), p = 0.99. Seven participants had pus discharge (all had been operated by non-doctors), 2 participants had bleeding at 2 h (one by doctor and one by non-doctor), and 4 participants had excessive skin removal (2 by doctors vs 2 by non-doctors). There was no reported urethral injury or glans amputation.ConclusionOur study found no statistically significant difference in the incidence of adverse events among VMMCs conducted by doctors compared to non-doctor health workers. Our study showed no incidence of serious adverse events such as death, urethral injury or glans amputation following VMMCs. Our results add to the existing literature to guide task shifting in the context of VMMCs.

Highlights

Voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission
In Uganda, previous studies have indicated a low incidence of adverse events following VMMCs carried out by non-doctor health workers [10, 11] and similar findings have been reported in other countries such as Kenya [12] and South Africa [13]
5 Conclusions Our study showed no incidence of serious adverse events such as death, urethral injury or glans amputation following VMMCs

Summary

Introduction

Voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission. Task shifting of VMMCs to non-doctor health workers is recommended to enhance scale-up of VMMC programs. This study evaluated outcomes of circumcision conducted by doctors compared to non-doctors in central Uganda. The region has a low doctor to population ratio of 0.16/1000 [6], and task shifting is recommended, such that VMMCs are conducted by non-doctor health workers such as nurses and clinical officers [7, 8]. A systematic review of outcomes of VMMCs conducted by doctors compared to non-doctors showed no difference in the incidence of adverse events between. In Uganda, previous studies have indicated a low incidence of adverse events following VMMCs carried out by non-doctor health workers [10, 11] and similar findings have been reported in other countries such as Kenya [12] and South Africa [13].

Methods

Results

Discussion

Conclusion