Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

06 January 2012

Shifting medical male circumcision to non-physician clinicians in Africa possible

via Aidsmap, by Carole Leach-Lemens

With proper training and supervision task shifting of medical male circumcision to non-physician clinicians in Africa can be done safely, according to researchers in South Africa and North America reporting in the advance online edition of AIDS.

This systematic review and analysis of ten studies (from South Africa, Kenya, Comoros, Nigeria, Zambian and Uganda) with information on over 25,000 circumcisions done by trained non-physician clinicians (nurses, midwives, surgical aides and clinical officers) found adverse events were not serious; and the pooled relative risk in two studies separately reporting outcomes for doctors and non-physicians showed comparable rates of adverse events (1.18: 95% CI: 0.78-1.78).

Evidence from randomised trials and observational studies support the protective effect of male circumcision for men getting HIV. Widespread male circumcision in Africa could prevent up to six million new infections and three million deaths in the next twenty years according to mathematical modelling estimates, note the authors.

With its potential as a high impact and cost-effective intervention both UNAIDS and the World Health Organization (WHO) promote voluntary male medical circumcision, with the latter providing guidelines for scaling-up of services in eastern and southern Africa.

In addition to ethical and acceptability challenges a severe shortage of health care workers in high prevalence countries, notably in Eastern and Southern Africa, is one of the major obstacles to effective scale-up.
Task shifting, the planned delegation of tasks from specialists or doctors to non-physician health care professionals, is a proposed strategy supported by WHO to increase scale-up of HIV treatment and prevention services. Randomised trials have provided evidence of the safety and efficacy of task shifting for ART.

To date evidence of the safety of circumcision by non-physician health care workers has been mixed. Reports of high rates of serious complications, note the authors, have confused those circumcisions undertaken by lay people with little or no training, lack of supervision or supportive equipment with circumcisions undertaken as a result of task shifting.

While there have been systematic reviews looking at the frequency of adverse events after circumcision, none have specifically looked at task shifting, note the authors.

The authors undertook a search of online databases and conference websites up to July 2011 reporting the outcomes of task shifting for circumcision in Africa.

Read the rest.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

No comments:

Post a Comment