Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
BMC Urol. 2020 Apr 25;20(1):45. doi: 10.1186/s12894-020-00613-6.
Male circumcision confers partial protection against heterosexual HIV acquisition among men. The President's Emergency Plan for AIDS Relief (PEPFAR) has supported > 18,900,000 voluntary medical male circumcisions (VMMC). Glans injuries (GIs) are rare but devastating adverse events (AEs) that can occur during circumcision. To address this issue, PEPFAR has supported multiple interventions in the areas of surveillance, policy, education, training, supply chain, and AE management.
Since 2015, PEPFAR has conducted surveillance of GIs including rapid investigation by the in-country PEPFAR team. This information is collected on standardized forms, which were reviewed for this analysis.
Thirty-six GIs were reported from 2015 to 2018; all patients were < 15 years old (~ 0·7 per 100,000 VMMCs in this age group) with a decreasing annual rate (2015: 0.7 per 100,000 VMMCs; 2018: 0.4 per 100,000 VMMC; p = 0.02). Most (64%) GIs were partial or complete amputations. All amputations among 10-14 year-olds occurred using the forceps-guided (FG) method, as opposed to the dorsal-slit (DS) method, and three GIs among infants occurred using a Mogen clamp. Of 19 attempted amputation repairs, reattached tissue was viable in four (21%) in the short term. In some cases, inadequate DS method training and being overworked, were found.
Following numerous interventions by PEPFAR and other stakeholders, GIs are decreasing; however, they have not been eliminated and remain a challenge for the VMMC program. Preventing further cases of complete and partial amputation will likely require additional interventions that prevent use of the FG method in young patients and the Mogen clamp in infants. Improving management of GIs is critical to optimizing outcomes.
男性割礼可部分降低男性通过异性性行为感染艾滋病毒的风险。总统防治艾滋病紧急救援计划（PEPFAR）已支持超过 1890 万例自愿男性割礼（VMMC）。龟头损伤（GI）是一种罕见但严重的不良事件（AE），可在割礼过程中发生。为了解决这个问题，PEPFAR 在监测、政策、教育、培训、供应链和 AE 管理等领域支持了多项干预措施。
自 2015 年以来，PEPFAR 一直在监测 GI，包括由本国 PEPFAR 团队进行快速调查。这些信息是通过标准化表格收集的，本分析对此进行了回顾。
2015 年至 2018 年报告了 36 例 GI；所有患者均<15 岁（该年龄组中约每 10 万例 VMMC 中有 0.7 例），且每年的发生率呈下降趋势（2015 年：每 10 万例 VMMC 中 0.7 例；2018 年：每 10 万例 VMMC 中 0.4 例；p=0.02）。大多数（64%）GI 为部分或完全截肢。所有 10-14 岁儿童的截肢都是用夹引导法（FG），而不是用背部切开法（DS），3 例婴儿的截肢是用莫根夹法进行的。在 19 例尝试的截肢修复中，4 例（21%）在短期内重新连接的组织具有活力。在某些情况下，发现 DS 方法的培训不足和过度劳累。
在 PEPFAR 和其他利益相关者采取了多项干预措施后，GI 正在减少；然而，它们并未被消除，仍然是 VMMC 项目的一个挑战。要防止进一步发生完全和部分截肢，可能需要采取其他干预措施，防止在年轻患者中使用 FG 方法和在婴儿中使用莫根夹法。改善 GI 的管理对于优化结果至关重要。
