Low adverse event rates following voluntary medical male circumcision in a high HIV disease burden public sector prevention programme in South Africa.

CAPRISA, 2014.Introduction: The provision of voluntary medical male circumcision (VMMC) services was piloted in three public sector facilities in a high HIV disease burden, low circumcision rate province in South Africa to inform policy and operational guidance for scale-up of the service for HIV prevention. We report on adverse events (AEs) experienced by clients following the circumcision procedure. Methods: Prospective recruitment of HIV-negative males aged 12 and older volunteering to be circumcised at three select public health facilities in KwaZulu-Natal between November 2010 and May 2011. Volunteers underwent standardized medical screening including a physical assessment prior to the surgical procedure being performed. AEs were monitored at three time intervals over a 21-day period post-operatively to determine safety outcomes in this pilot demonstration programme. Results: A total of 602 volunteers participated in this study. The median age of the volunteers was 22 years (range 12-56). Most participants (75.6%) returned for the 48-hour post-operative visit; 51.0% for day seven visit and 26.1% for the 21st day visit. Participants aged 20-24 were most likely to return. The AE rate was 0.2% intra-operatively. The frequency of moderate AEs was 0.7, 0.3 and 0.6% at 2-, 7- and 21-day visits, respectively. The frequency of severe AEs was 0.4, 0.3 and 0.6% at 2-, 7- and 21-day visits, respectively. Swelling and wound infection were the most common AEs with mean appearance duration of seven days. Clients aged between 35 and 56 years presented with most AEs (3.0%). Conclusions: VMMC can be delivered safely at resource-limited settings. The intensive three-visit post-operative review practice may be unfeasible due to high attrition rates over time, particularly amongst older men

Effects of introducing Xpert MTB/RIF test on multi-drug resistant tuberculosis diagnosis in KwaZulu-Natal South Africa.

CAPRISA, 2014.Abstract available in pdf

Health workers’ perspectives on implementation of an integrated medical male circumcision strategy in KwaZulu-Natal, South Africa

Background: KwaZulu-Natal province began implementation of voluntary medical male circumcision (VMMC) as an integral part of its HIV infection prevention strategy that includes other programmes such as HIV counselling and testing (HCT), screening and treatment of sexually transmitted infections and tuberculosis, and other sexual and reproductive health services. This followed randomised controlled trials that showed up to 60% HIV infection risk reduction amongst circumcised men. Implementation of the strategy occurred despite absence of knowledge of operational barriers and its acceptability to health care workers (HCWs). Objectives: The study aimed to explore HCWs’ perspectives of and barriers to strategy implementation at public sector health facilities to inform implementation policy. Method: A purposive quota sampling method was used to select HCWs for focus group discussions at three study sites. Participants were asked open-ended questions using an interview schedule based on a literature review to explore acceptability of and perceptions regarding provision of the strategy. Thematic analysis was conducted. Results: Acceptability of the strategy was high amongst the participants; however, there was limited knowledge of some key concepts of the strategy, personnel role confusion, missed opportunities for client recruitment, and infrastructural constraints. Negative perceptions included beliefs that VMMC would discourage condom use and cause stigma associated with non-circumcision of HIV-positive males, with perceptions of sexual behavioural disinhibition in circumcised men. Conclusion: There is a need to engage further with stakeholders if implementation of VMMC is to be successful. More training and support needs to be provided to HCWs at public sector facilities. Agtergrond: Die implementering van vrywillige mediese manlike besnyding (VMMC) is ’n integrale deel van KwaZulu-Natal provinsie se MIV-voorkomingstrategie, wat ander programme soos MIV-berading, siftingstoetse (HCT) en die behandeling van seksuele oordraagbare siektes (STI), asook ander seksuele en reproduksie-gesondheidsdienste (geïntegreerde VMMC) insluit. Dit volg op die resultate van ewekansige gekontroleerde steekproewe wat ’n doeltreffendheid getoon het van tot 60% vermindering in HIV-risiko onder mans wat besny is. Die implementering van die strategie het plaasgevind ten spyte van die afwesigheid van kennis van operasionele struikelblokke of aanvaarding deur gesondheidswerkers (HCWs). Doelwitte: Die studie is daarop gerig om HCW se perspektiewe en hindernisse vir die implementering van die VMMC program by die openbare sektor se gesondheidsfasiliteite te verken, ten einde die uitvoering van die beleid vas te stel. Metode: Die doelgerigte kwotasteekproefmetode is gebruik om HCW deelnemers vir fokusgroepbesprekings (FGDs) op drie studieterreine te kies. Deelnemers is oop vrae gevra met behulp van ’n onderhoudskedule gebaseer op ’n literatuuroorsig van die aanvaarbaarheid en persepsies aangaande die voorsiening van die strategie. Tematiese analise is in ooreenstemming met die doelwitte van die studie gedoen. Resultate: Die aanvaarbaarheid van VMMC was hoog onder die deelnemers, maar ’n paar probleemareas is geïdentifieer: beperkte kennis van belangrike begrippe van die strategie, personeelrolverwarring, geleenthede vir kliëntwerwing en infrastruktuurbeperkings. Negatiewe persepsies het ingesluit: oortuigings dat VMMC die gebruik van kondome sou voorkom, die stigma wat verband hou met onbesnede HIV-positiewe mans en die persepsie van onderdrukte seksuele gedrag by mans wat besny is

Access to antiretroviral treatment by children in KwaZulu-Natal Province : a qualitative exploratory study into factors influencing poor access.

Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2009.South Africa and the province of KwaZulu-Natal (KZN) has one of the greatest HIV burdens in the world with an estimated 5.7 mHIion people living with HIV/AIDS. One of the interventions that the government introduced to address this situation was the provision of antiretroviral treatment (ART) to those individuals that are eligible for HIV treatment in order to reduce the morbidity and mortality. Despite widespread availability of ART in KZN, children do not access ART to the extent that adults do, and therefore continue to die because of HIV and AIDS. This qualitative study explored the psychosocial and health system factors that influence paediatric access to ART in KZN from parents and caregivers perspectives. The ecological theory and the social cognitive theory was used to formulate an interview schedule used in conducting the in-depth interviews with adults (parents or guardians) who were bringing their children for ARTservices and those attending these services themselves and not their children at Edendale and King Edward Hospitals in KZN. Purposive sampling was used to select clients for interviews and thematic was done in accordance with the aims and objectives of the study. A total of 42 participants were interviewed in this study. The low uptake of child ART was found to be influenced by several psychosocial and economic factors such as the poor knowledge about ART, stigma and disclosure associated with HIV, extent of support provided by parents/caregivers, parent's own ART was a determinant for bringing children for ART, use of traditional / alternative medicines, disintegrated families, especially the issue of multiple caregivers, complexity of paediatric ART, poor referrals of children from community institutions, unsatisfactory service at clinics, and some health policy and legislation with respect to health care for HIV-infected children that had an unintended effect of restricting child access to ART as well as poverty related Issues. Improving knowledge and self-efficacy related to ART, prevention of mother to child transmission ofHIV, re-training of health workers on child issues and addressing stigma and discrimination and other psychosocial and institutional problems and logistics could help to improve the low paediatric uptake of ART

Acceptability of neonatal circumcision by pregnant women in KwaZulu-Natal, South Africa

Background: Studies on voluntary medical male circumcision (VMMC) have provided convincing evidence on its efficacy to provide partial protection against female-to-male HIV transmission in circumcised men. The World Health Organization and UNAIDS subsequently formulated recommendations for VMMC implementation that included implementation of neonatal medical male circumcision (NMMC) to all infants up to two months old. Knowledge regarding the acceptability of NMMC by pregnant women who are candidates for granting of consents for NMMC procedures or its ideal placement within health programmes is low. Objectives: We sought to establish NMMC acceptability by pregnant women and the feasibility of its integration within Maternal, Child and Women’s Health (MCWH) programmes to inform implementation guidelines. Method: Nurses and counsellors at two public health facilities were trained to provide NMMC counselling and offer NMMC to 1778 pregnant women presenting for antenatal care services. Univariate and bivariate analyses were performed on data collected on NMMC acceptance and refusals. Thematic analysis was also performed on qualitative reasons for refusals. Results: Acceptability of NMMC by women was high (82.9%). Refusals resulted from the need for consultations with partners and/or family members prior to consenting (41.3%), fear of the procedure (23.8%), cultural reasons (15.9%) and no reasons given (15.3%). Conclusion: The acceptability of NMMC by pregnant women and its integration with MCWH services was feasible. However socio-cultural factors, including the need for further consultation prior to consenting for NMMC procedures and preference of traditional circumcision by some women, need to be addressed in order to increase uptakes