Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-4 (of 4 Records) |
Query Trace: Wamai N [original query] |
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Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention - 15 African countries, 2015-2019
Lucas T , Hines JZ , Samuelson J , Hargreave T , Davis SM , Fellows I , Prainito A , Watts DH , Kiggundu V , Thomas AG , Ntsuape OC , Dare K , Odoyo-June E , Soo L , Toti-Mokoteli L , Manda R , Kapito M , Msungama W , Odek J , Come J , Canda M , Gaspar N , Mekondjo A , Zemburuka B , Bonnecwe C , Vranken P , Mmbando S , Simbeye D , Rwegerera F , Wamai N , Kyobutungi S , Zulu JE , Chituwo O , Xaba S , Mandisarisa J , Toledo C . BMC Urol 2021 21 (1) 23 BACKGROUND: Voluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President's Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions. METHODS: Demographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group. RESULTS: In total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6-2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14-27). CONCLUSIONS: Urethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2-3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR's recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years. |
Bleeding and blood disorders in clients of voluntary medical male circumcision for HIV prevention - Eastern and Southern Africa, 2015-2016
Hinkle LE , Toledo C , Grund JM , Byams VR , Bock N , Ridzon R , Cooney C , Njeuhmeli E , Thomas AG , Odhiambo J , Odoyo-June E , Talam N , Matchere F , Msungama W , Nyirenda R , Odek J , Come J , Canda M , Wei S , Bere A , Bonnecwe C , Choge IA , Martin E , Loykissoonlal D , Lija GJI , Mlanga E , Simbeye D , Alamo S , Kabuye G , Lubwama J , Wamai N , Chituwo O , Sinyangwe G , Zulu JE , Ajayi CA , Balachandra S , Mandisarisa J , Xaba S , Davis SM . MMWR Morb Mortal Wkly Rep 2018 67 (11) 337-339 Male circumcision reduces the risk for female-to-male human immunodeficiency virus (HIV) transmission by approximately 60% (1) and has become a key component of global HIV prevention programs in countries in Eastern and Southern Africa where HIV prevalence is high and circumcision coverage is low. Through September 2017, the President's Emergency Plan for AIDS Relief (PEPFAR) had supported 15.2 million voluntary medical male circumcisions (VMMCs) in 14 priority countries in Eastern and Southern Africa (2). Like any surgical intervention, VMMC carries a risk for complications or adverse events. Adverse events during circumcision of males aged >/=10 years occur in 0.5% to 8% of procedures, though the majority of adverse events are mild (3,4). To monitor safety and service quality, PEPFAR tracks and reports qualifying notifiable adverse events. Data reported from eight country VMMC programs during 2015-2016 revealed that bleeding resulting in hospitalization for >/=3 days was the most commonly reported qualifying adverse event. In several cases, the bleeding adverse event revealed a previously undiagnosed or undisclosed bleeding disorder. Bleeding adverse events in men with potential bleeding disorders are serious and can be fatal. Strategies to improve precircumcision screening and performance of circumcisions on clients at risk in settings where blood products are available are recommended to reduce the occurrence of these adverse events or mitigate their effects (5). |
Notes from the field: Tetanus cases after voluntary medical male circumcision for HIV prevention - Eastern and Southern Africa, 2012-2015
Grund JM , Toledo C , Davis SM , Ridzon R , Moturi E , Scobie H , Naouri B , Reed JB , Njeuhmeli E , Thomas AG , Benson FN , Sirengo MW , Muyenzi LN , Lija GJ , Rogers JH , Mwanasalli S , Odoyo-June E , Wamai N , Kabuye G , Zulu JE , Aceng JR , Bock N . MMWR Morb Mortal Wkly Rep 2016 65 (2) 36-7 Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60% (1), and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision (2). As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs (3). |
Implementation and operational research: Strengthening HIV Test Access and Treatment Uptake Study (Project STATUS): A randomized trial of HIV testing and counseling interventions
McNaghten AD , Schilsky Mneimneh A , Farirai T , Wamai N , Ntiro M , Sabatier J , Makhunga-Ramfolo N , Mwanasalli S , Awor A , Moore J . J Acquir Immune Defic Syndr 2015 70 (4) e140-6 OBJECTIVE: To determine which of 3 HIV testing and counseling (HTC) models in outpatient departments (OPDs) increases HIV testing and entry of newly identified HIV-infected patients into care. DESIGN: Randomized trial of HTC interventions. METHODS: Thirty-six OPDs in South Africa, Tanzania, and Uganda were randomly assigned to 3 different HTC models: (A) health care providers referred eligible patients (aged 18-49, not tested in the past year, not known HIV positive) to on-site voluntary counseling and testing for HTC offered and provided by voluntary counseling and testing counselors after clinical consultation; (B) health care providers offered and provided HTC to eligible patients during clinical consultation; and (C) nurse or lay counselors offered and provided HTC to eligible patients before clinical consultation. Data were collected from October 2011 to September 2012. We describe testing eligibility and acceptance, HIV prevalence, and referral and entry into care. Chi-square analyses were conducted to examine differences by model. RESULTS: Of 79,910 patients, 45% were age eligible and 16,099 (45%) age eligibles were tested. Ten percent tested HIV positive. Significant differences were found in percent tested by model. The proportion of age eligible patients tested by Project STATUS was highest for model C (54.1%, 95% confidence interval [CI]: 42.4 to 65.9), followed by model A (41.7%, 95% CI: 30.7 to 52.8), and then model B (33.9%, 95% CI: 25.7 to 42.1). Of the 1596 newly identified HIV positive patients, 94% were referred to care (96.1% in model A, 94.7% in model B, and 94.9% in model C), and 58% entered on-site care (74.4% in model A, 54.8% in model B, and 55.6% in model C) with no significant differences in referrals or care entry by model. CONCLUSIONS: Model C resulted in the highest proportion of all age-eligible patients receiving a test. Although 94% of STATUS patients with a positive test result were referred to care, only 58% entered care. We found no differences in patients entering care by HTC model. Routine HTC in OPDs is acceptable to patients and effective for identifying HIV-infected persons, but additional efforts are needed to increase entry to care. |
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