Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
AIDS. 2012 Mar 13;26(5):559-66. doi: 10.1097/QAD.0b013e32834f3264.
Task-shifting for male medical circumcision is proposed as a strategy to overcome the lack of surgeons and doctors in high HIV prevalence settings. We undertook a systematic review and meta-analysis to review the safety of task-shifting for circumcision in Africa.
We searched online databases and conference websites up to July 2011 without language restriction for studies reporting outcomes of task-shifting for circumcision in Africa. Information was extracted independently and in duplicate on study characteristics, quality, and outcome data. Case reports and case series were excluded.
Ten studies met our inclusion criteria, providing outcome data on 25119 circumcisions. The proportion of adverse events ranged from 0.70 [95% confidence interval (CI) 0.44-1.02%] to 37.36% (95% CI 27.54-47.72%), with an overall pooled proportion of 2.31% (95% CI 1.46-3.16%; τ = 1.21; P < 0.001). Two studies reported outcomes separately for both doctors and non-physicians; there was no difference in the risk of adverse events by provider (pooled relative risk 1.18; 95% CI 0.78-1.78). The frequency of excessive bleeding ranged from 0.30 (0.09-0.65%) to 24.71% (16.27-34.26%) with an overall pooled prevalence of 0.55% (95% CI 0.13-0.97%). Infection occurred in 0.30 (0.14-1.47%) to 1.85% (0.07-5.96%) of cases, with an overall pooled proportion of 0.88% (95% CI 0.29-1.47%). All adverse events were reported to be non-severe.
Task-shifting of male medical circumcision to non-physician clinicians can be done safely, with reported rates of adverse events similar to doctors and specialists.
在高艾滋病毒流行地区，将男性医疗环切术任务转移给非医生是一种克服外科医生和医生短缺的策略。我们进行了系统评价和荟萃分析，以审查在非洲转移任务进行环切术的安全性。
我们在网上数据库和会议网站上进行了搜索，截至 2011 年 7 月，没有语言限制，以检索报告非洲环切术任务转移结果的研究。信息由独立的两个人提取，内容包括研究特征、质量和结果数据。排除病例报告和病例系列。
十项研究符合纳入标准，提供了 25119 例环切术的结果数据。不良事件的比例从 0.70 [95%置信区间（CI）0.44-1.02%]到 37.36%（95% CI 27.54-47.72%）不等，总体汇总比例为 2.31%（95% CI 1.46-3.16%；τ=1.21；P<0.001）。两项研究分别报告了医生和非医生的结果；提供者的不良事件风险没有差异（汇总相对风险 1.18；95% CI 0.78-1.78）。过度出血的频率从 0.30（0.09-0.65%）到 24.71%（16.27-34.26%）不等，总体汇总流行率为 0.55%（95% CI 0.13-0.97%）。感染发生在 0.30（0.14-1.47%）至 1.85%（0.07-5.96%）的病例中，总体汇总比例为 0.88%（95% CI 0.29-1.47%）。所有不良事件均报告为非严重事件。
将男性医疗环切术任务转移给非医生临床医生是安全的，可以安全地进行，不良事件发生率与医生和专家相似。
