INSERM U1018 Centre de Recherche en Epidémiologie et Santé des Populations (CESP), Villejuif, France.
PLoS Med. 2010 Jul 20;7(7):e1000309. doi: 10.1371/journal.pmed.1000309.
World Health Organization (WHO)/Joint United Nations Programme on AIDS (UNAIDS) has recommended adult male circumcision (AMC) for the prevention of heterosexually acquired HIV infection in men from communities where HIV is hyperendemic and AMC prevalence is low. The objective of this study was to investigate the feasibility of the roll-out of medicalized AMC according to UNAIDS/WHO operational guidelines in a targeted African setting.
The ANRS 12126 "Bophelo Pele" project was implemented in 2008 in the township of Orange Farm (South Africa). It became functional in 5 mo once local and ethical authorizations were obtained. Project activities involved community mobilization and outreach, as well as communication approaches aimed at both men and women incorporating broader HIV prevention strategies and promoting sexual health. Free medicalized AMC was offered to male residents aged 15 y and over at the project's main center, which had been designed for low-income settings. Through the establishment of an innovative surgical organization, up to 150 AMCs under local anesthesia, with sterilized circumcision disposable kits and electrocautery, could be performed per day by three task-sharing teams of one medical circumciser and five nurses. Community support for the project was high. As of November 2009, 14,011 men had been circumcised, averaging 740 per month in the past 12 mo, and 27.5% of project participants agreed to be tested for HIV. The rate of adverse events, none of which resulted in permanent damage or death, was 1.8%. Most of the men surveyed (92%) rated the services provided positively. An estimated 39.1% of adult uncircumcised male residents have undergone surgery and uptake is steadily increasing.
This study demonstrates that a quality AMC roll-out adapted to African low-income settings is feasible and can be implemented quickly and safely according to international guidelines. The project can be a model for the scale-up of comprehensive AMC services, which could be tailored for other rural and urban communities of high HIV prevalence and low AMC rates in Eastern and Southern Africa. Please see later in the article for the Editors' Summary.
世界卫生组织（WHO）/联合国艾滋病规划署（UNAIDS）建议在 HIV 高度流行且男性割礼率（AMC）较低的社区，对男性进行成人男性割礼（AMC）以预防异性恋获得性 HIV 感染。本研究的目的是根据 UNAIDS/WHO 的操作指南，在一个有针对性的非洲环境中调查推出医学 AMC 的可行性。
2008 年，非政府组织“Bophelo Pele”项目在南非奥兰治农场镇实施。一旦获得当地和伦理授权，该项目在 5 个月内开始运作。项目活动包括社区动员和外展，以及针对男女的沟通方法，纳入更广泛的 HIV 预防策略并促进性健康。该项目的主要中心为 15 岁及以上的男性居民提供免费的医学 AMC，该中心是为低收入环境设计的。通过建立创新的手术组织，可以由三个分担任务的团队在局部麻醉下，每天为多达 150 名男性进行 AMC，每个团队由一名医疗割礼师和五名护士组成，使用消毒的割礼一次性套件和电烙术。社区对该项目的支持度很高。截至 2009 年 11 月，已有 14011 名男性接受了割礼，过去 12 个月平均每月 740 人，27.5%的项目参与者同意接受 HIV 检测。不良事件发生率为 1.8%，无一例导致永久性损伤或死亡。接受调查的大多数男性（92%）对所提供的服务给予了积极评价。估计有 39.1%的未割礼成年男性居民接受了手术，接受率稳步上升。
本研究表明，适应非洲低收入环境的高质量 AMC 推广是可行的，并且可以根据国际指南快速安全地实施。该项目可以作为在东非和南非高 HIV 流行率和低 AMC 率的农村和城市社区扩大 AMC 服务的典范。请在文章后面查看编辑摘要。
