Cost in USD (%) of one MC surgery using PrePex and forceps-guided method under various assumptions.

<p>AE, Adverse Event; F/U, follow-up; not all percentages add to 100 due to rounding.</p><p><b>Consumable Supplies.</b><i>Both methods:</i> non-sterile gloves, alcohol hand rub, antiseptic soap, providone antiseptic solution, diclofenac {analgesic} tabs, paraffin gauze {Vaseline gauze}, gauze swabs, cohesive bandage. <i>PMC:</i> Lignocaine cream {local anesthesia cream}. <i>FGMC:</i> sterile gloves, face mask, Bupivacaine, Lignocaine, Needles (21 gauge and 19 gauge), 10 ml syringe, surgical blade (size 10), chromic catgut suture 3/0.</p><p><b>Non-consumable supplies.</b><i>Both methods:</i> client underpants. <i>FGMC:</i> weighing scale, blood pressure cuff, thermometer, surgical scrubs, shoe cover, sterile drape, center 'o', circumcision surgical tray (gallipot Kocher clamp mosquito artery forceps, blade holder, kidney dish, Dunhill artery forceps, tissue scissors, suture scissors, Adson forceps, needle holder, sponge holding forceps), emergency tray supplies. <i>PMC:</i> dressing tray (kidney dish, gallipot, sponge holding forceps, scissors).</p><p><b>Direct Personnel:</b><i>Both methods:</i> counselor, hygiene officer. <i>FGMC:</i> Clinical officer, nurse, consultant urologist (for AEs). <i>PMC:</i> Nurse/nurse pair or nurse/nurse aide pair.</p><p><b>Training:</b><i>Both methods</i>: 3 days of theory. <i>FGMC:</i> 7 days practicum PMC: 3 days practicum; costs include staff time, lunch/refreshments for participants and trainers, stationery, and MC manual.</p><p><b>Capital:</b><i>Both methods:</i> autoclave (PMC assumed to use 1/2 that of FGMC), surgical couch, cell phones, incinerator, office furniture, vehicles, facility space, generator, surgical equipment (mayo tray, trolley, waste bin).</p><p><b>Maintenance and Utility:</b><i>Both methods:</i> internet, office rent, electricity (power), water, vehicle costs (maintenance, insurance, and fuel). <i>FGMC:</i> facility renovations.</p><p><b>Support Personnel:</b><i>Both methods:</i> MOH supervision, quality assurance/quality improvement (QA/QI) team, training team, department managers and staff (human resources, transport, finance, administration, stores, information technology, data, mobilization). <i>PMC:</i> MOH supervision, mobilization team, QA/QI team and training team assumed to require 1/2 the full-time equivalents of FGMC.</p><p><b>Management and Supervision:</b><i>Both methods:</i> senior management team salaries, travel expenses for circumcision camps and management supervision.</p

Type and frequency of adverse events and other events.

<p>AE, adverse event; IMC, infant male circumcision.</p

Adverse event rate and risk factors for adverse events in research and non-research circumcisions.

<p>AE, adverse event; CI, confidence interval; IMC, infant male circumcision; OR, odds ratio.</p

Characteristics of research and non-research IMC procedures.

<p>IQR, Inter-quartile range; N/A, Not applicable.</p>‡<p>Question wording: “If you were to do it again, would you circumcise your baby?”</p

AccuCirc Study Forms & Parent Questionnaire

This PDF file contains the parent questionnaire and study forms used in the collection of the data

Accucirc Code Book

Code book for AccuCirc dat

Prospective comparison of two models of integrating early infant male circumcision with maternal child health services in Kenya: The Mtoto Msafi Mbili Study

<div><p>As countries scale up adult voluntary medical male circumcision (VMMC) for HIV prevention, they are looking ahead to long term sustainable strategies, including introduction of early infant male circumcision (EIMC). To address the lack of evidence regarding introduction of EIMC services in sub-Saharan African settings, we conducted a simultaneous, prospective comparison of two models of EIMC service delivery in Homa Bay County, Kenya. In one division a standard delivery package (SDP) was introduced and included health facility-based provision of EIMC services with community engagement for client referral versus in a different division a standard package plus (SDPplus) that included community-delivered EIMC services. Babies 1–60 days old were eligible for EIMC. A representative sample of mothers and fathers of baby boys at 16 health facilities was surveyed. We examined differences between mothers and fathers in the SDP and SDPplus divisions and identified factors associated with EIMC uptake. We report adjusted prevalence ratios (aPR). Of 1660 mothers interviewed, 1501 (89%) gave approval to contact the father, and 1259 fathers (84%) were interviewed. The proportion of babies circumcised was slightly greater in the SDPplus division than the SDP division (27.3% vs 23.7%), but the difference was not significant (p = 0.08). In adjusted analyses, however, the prevalence of babies being circumcised was greater in the SDPplus division (aPR = 1.23, 95% CI:1.04–1.45) and the factors associated with a baby being circumcised were the mother having received information about EIMC (during pregnancy, aPR = 4.81, 95% CI: 2.21–3.42), having discussed circumcision with the father if married or cohabiting (aPR = 5.39, 95% CI: 3.31–8.80) or being single (aPR = 5.67, 95% CI: 3.31–9.69), perceiving herself to be living with HIV (aPR = 1.39, 95% CI: 1.15–1.67), or having a post-secondary education (aPR = 1.33, 95% CI: 1.04–1.69), and the father being Muslim (aPR = 1.85, 95% CI: 1.29–2.65) or circumcised (aPR = 1.34, 95% CI: 1.13–1.59). The median age of 2117 babies circumcised was 8 days (IQR: 1–36), and the median weight was 3.6 kg (IQR: 3.2–4.4). There were 6 moderate adverse events (AEs) (0.28%); 5 severe AEs (0.24%), all involving an injury to the glans penis, requiring hospitalization and corrective surgery; and one death probably related to the procedure. There were no AEs among the 365 procedures performed outside health facilities. Information and education campaigns must reach members of the general population, especially men and fathers, who are influential to the EIMC decision. Serious AEs using the Mogen clamp are rare, but do occur and require efficient, reliable emergency back-up. Our results can assist countries considering scale-up of EIMC services for HIV prevention as their adult VMMC programs mature.</p></div

Characteristics of mothers (<i>N</i> = 1,660^a) in Rachuonyo, western Kenya, by circumcision status of their infant male, Mtoto Msafi Mbili Study, September 2014 –July 2016.

<p>Characteristics of mothers (<i>N</i> = 1,660<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0184170#t004fn002" target="_blank">^a</a>) in Rachuonyo, western Kenya, by circumcision status of their infant male, Mtoto Msafi Mbili Study, September 2014 –July 2016.</p

Information and discussion among mothers (<i>N</i> = 1,660^a) in Rachuonyo, western Kenya, by treatment group, Mtoto Msafi Mbili Study, September 2014 –July 2016.

<p>Information and discussion among mothers (<i>N</i> = 1,660<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0184170#t003fn001" target="_blank">^a</a>) in Rachuonyo, western Kenya, by treatment group, Mtoto Msafi Mbili Study, September 2014 –July 2016.</p

Multivariate models of factors associated with infant male circumcision in Rachuonyo, western Kenya, Mtoto Msafi Mbili Study, September 2014 –July 2016, N = 1660.

<p>Multivariate models of factors associated with infant male circumcision in Rachuonyo, western Kenya, Mtoto Msafi Mbili Study, September 2014 –July 2016, N = 1660.</p