Messaging Circumstances and Economic Pressures as Influences on Linkage to Medical Male Circumcision following Community-Based HIV Testing for Men in Rural Southwest Uganda: A Qualitative Study

Description of adverse events among adult men following voluntary medical male circumcision: Findings from a circumcision programme in two provinces of South Africa

BACKGROUND

Clinical trials showed strong evidence that voluntary medical male circumcision (VMMC) reduces the acquisition of HIV among heterosexual men by up to 60%. However, VMMC uptake in East and Southern Africa remains suboptimal, with safety concerns identified as a barrier to uptake. We investigated the occurrence and severity of adverse events (AEs) in a routine VMMC programme implemented in Gauteng and North West provinces of South Africa.

METHODS

We describe the frequency and characteristics of AEs using routinely collected data from a VMMC programme implemented between 01 May 2013 and 31 December 2014. The surgical procedure was provided at fixed clinics and mobile units in three districts. Adult men undertaking the procedure were referred for follow-up appointments where AEs were monitored.

RESULTS

A total of 7,963 adult men were offered the VMMC service with 7,864 (98.8%) met the age and consent requirements for inclusion in a research follow-up after the surgical procedure and were followed-up for potential AEs. In total, 37 (0.5%) patients reported AEs post-surgery with infection [11 (29.7%)] and excessive bleeding [11 (29.7%)] commonly reported AEs. In terms of severity, 14 (37.8%) were classified as mild, 13 (35.1%) as moderate, and 10 (27.0%) as severe. Further, 32 (86.5%) of the AEs were classified as definitely related to the surgical procedure, with 36 (97.5%) of all AEs resolving without sequelae.

CONCLUSION

The VMMC programme was able to reach adult men at high risk of HIV acquisition. Reported AEs in the programme were minimal, with the observed safety profile comparable to clinical trial settings, suggesting that VMMC can be safely administered in a programmatic setting.

Demand creation for primary biomedical prevention: identifying lessons across interventions to inform daily oral preexposure prophylaxis programs

PURPOSE OF REVIEW

At a moment when UNAIDS (Joint United Nations Programme on HIV/AIDS) has acknowledged a 'prevention crisis,' and multiple countries and implementers are emphasizing 'user-centered' and/or differentiated models of delivering HIV treatment and prevention, it is essential to understand and act on best practices from all relevant interventions to create effective oral preexposure prophylaxis (PrEP) programs.

RECENT FINDINGS

It is possible to adapt private sector approaches to understanding and segmenting the preferences and mindsets of potential consumers to primary HIV prevention programs, as demonstrated by a voluntary medical male circumcision (VMMC)-focused intervention that successfully trained and supported counselors to identify and deliver tailored messages to men potentially undergoing VMMC. Literature on PrEP and demand creation is less extensive and suggests uneven application of user-centered design and demand-side thinking; a recent analysis of condom programing demonstrates that failure to maintain resources for social marketing can drive a collapse in use and an increase in HIV incidence.

SUMMARY

Approaches to demand creation for primary prevention are dynamic and evolving. However, the lag between implementation and publication means that there is a paucity of PrEP-specific information. Insights from VMMC and other strategies can and must be considered as part of a more holistic approach to increasing demand for primary prevention interventions.