Right to Care, Johannesburg, South Africa.
Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2022 Sep 23;17(9):e0270545. doi: 10.1371/journal.pone.0270545. eCollection 2022.
Voluntary medical male circumcision (VMMC) remains an effective biomedical intervention for HIV prevention in high HIV prevalence countries. In South Africa, United States Agency for International Development VMMC partners provide technical assistance to the Department of Health, at national and provincial levels in support of the establishment of VMMC sites as well as in providing direct VMMC services at site level since April 2012. We describe the outcomes of the Right to Care (RTC) VMMC program implemented in South Africa from 2012 to 2017.
This retrospective study was undertaken at RTC supported facilities across six provinces. Young males aged ≥10 years who presented at these facilities from 1 July 2012 to 31 September 2017 were included. Outcomes were VMMC uptake, HIV testing uptake and rate of adverse events (AEs). Using a de-identified observational database of these clients, summary statistics of the demographic characteristics and outcomes were calculated.
There were a total 1,001,226 attendees of which 998,213 (99.7%) were offered VMMC and had a median age of 15 years (IQR = 12-23 years). Of those offered VMMC, 99.6% (994,293) consented, 96.7% (965,370) were circumcised and the majority (46.3%) were from Gauteng province. HIV testing uptake was 71% with a refusal rate of 15%. Of the newly diagnosed HIV positives, 64% (6,371 / 9,972) referrals were made. The rate of AEs, defined as bleeding, infection, and insufficient skin removal) declined from 3.26% in 2012 to 1.17% in 2017. There was a reduction in infection-related AEs from 2,448 of the 2,602 adverse events (94.08%) in 2012 to 129 of the 2,069 adverse events (6.23%) in 2017.
There was a high VMMC uptake with a decline in AEs over time. Adolescent men contributed the most to the circumcised population, an indication that the young population accesses medical circumcision more. VMMC programs need to implement innovative demand creation strategies to encourage older males (20-34 years) at higher risk of HIV acquisition to get circumcised for immediate impact in reduction of HIV incidence. HIV prevalence in the total population increased with increasing age, notably in clients above 25 years.
自愿男性包皮环切术（VMMC）仍然是高 HIV 流行国家预防 HIV 的有效生物医学干预措施。在南非，美国国际开发署的 VMMC 合作伙伴在国家和省级层面为卫生部提供技术援助，以支持 VMMC 场所的建立，并自 2012 年 4 月以来在现场一级提供直接的 VMMC 服务。我们描述了 2012 年至 2017 年期间在南非实施的 Right to Care（RTC）VMMC 计划的结果。
本回顾性研究在六个省份的 RTC 支持设施中进行。从 2012 年 7 月 1 日至 2017 年 9 月 31 日，年龄在 10 岁及以上的年轻男性在这些设施就诊。使用这些客户的匿名观察数据库，计算了人口统计学特征和结果的汇总统计数据。
共有 1,001,226 名就诊者，其中 998,213 名（99.7%）接受了 VMMC 并中位年龄为 15 岁（IQR = 12-23 岁）。在接受 VMMC 的就诊者中，99.6%（994,293）同意，96.7%（965,370）接受了环切术，其中大多数（46.3%）来自豪登省。HIV 检测率为 71%，拒绝率为 15%。在新诊断的 HIV 阳性者中，64%（6,371 / 9,972）进行了转介。定义为出血、感染和皮肤去除不足的不良事件（AE）发生率从 2012 年的 3.26%下降到 2017 年的 1.17%。感染相关 AE 从 2012 年的 2,602 例不良事件（94.08%）中的 2,448 例减少到 2017 年的 2,069 例不良事件（6.23%）中的 129 例。
VMMC 的接受率很高，AE 随时间下降。青少年男性对接受环切术的人群贡献最大，这表明年轻人群更倾向于接受医疗环切术。VMMC 计划需要实施创新的需求创造策略，鼓励年龄较大（20-34 岁）、HIV 感染风险较高的男性进行环切术，以立即减少 HIV 发病率。总人群中的 HIV 流行率随年龄增长而增加，在 25 岁以上的患者中尤为明显。
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