Voluntary medical male circumcision for HIV prevention among adolescents in Kenya: Unintended consequences of pursuing service-delivery targets
Autoři:
Adam Gilbertson aff001; Barrack Ongili aff004; Frederick S. Odongo aff004; Denise D. Hallfors aff001; Stuart Rennie aff002; Daniel Kwaro aff004; Winnie K. Luseno aff001
Působiště autorů:
Pacific Institute for Research and Evaluation (PIRE), Chapel Hill, North Carolina, United States of America
aff001; UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
aff002; Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
aff003; Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
aff004
Vyšlo v časopise:
PLoS ONE 14(11)
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pone.0224548
Souhrn
Introduction
Voluntary medical male circumcision (VMMC) provides significant reductions in the risk of female-to-male HIV transmission. Since 2007, VMMC has been a key component of the United States President’s Emergency Plan for AIDS Relief’s (PEPFAR) strategy to mitigate the HIV epidemic in countries with high HIV prevalence and low circumcision rates. To ensure intended effects, PEPFAR sets ambitious annual circumcision targets and provides funding to implementation partners to deliver local VMMC services. In Kenya to date, 1.9 million males have been circumcised; in 2017, 60% of circumcisions were among 10-14-year-olds. We conducted a qualitative field study to learn more about VMMC program implementation in Kenya.
Methods and results
The study setting was a region in Kenya with high HIV prevalence and low male circumcision rates. From March 2017 through April 2018, we carried out in-depth interviews with 29 VMMC stakeholders, including “mobilizers”, HIV counselors, clinical providers, schoolteachers, and policy professionals. Additionally, we undertook observation sessions at 14 VMMC clinics while services were provided and observed mobilization activities at 13 community venues including, two schools, four public marketplaces, two fishing villages, and five inland villages. Analysis of interview transcripts and observation field notes revealed multiple unintended consequences linked to the pursuit of targets. Ebbs and flows in the availability of school-age youths together with the drive to meet targets may result in increased burdens on clinics, long waits for care, potentially misleading mobilization practices, and deviations from the standard of care.
Conclusion
Our findings indicate shortcomings in the quality of procedures in VMMC programs in a low-resource setting, and more importantly, that the pursuit of ambitious public health targets may lead to compromised service delivery and protocol adherence. There is a need to develop improved or alternative systems to balance the goal of increasing service uptake with the responsible conduct of VMMC.
Klíčová slova:
Teachers – Kenya – Schools – United States – Adolescents – HIV epidemiology – Circumcision
Zdroje
1. Weiss HA. Male circumcision as a preventive measure against HIV and other sexually transmitted diseases. Current Opinion In Infectious Diseases. 2007;20(1):66–72. doi: 10.1097/QCO.0b013e328011ab73 17197884.
2. Sharma SC, Raison N, Khan S, Shabbir M, Dasgupta P, Ahmed K. Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis. BJU International. 2018;121(4):515–26. doi: 10.1111/bju.14102 29232046.
3. Fink AJ. A possible explanation for heterosexual male infection with AIDS. The New England journal of medicine. 1986;315(18):1167–.
4. Reed JB, Njeuhmeli E, Thomas AG, Thomas AG, Bacon MC, Bailey R, et al. Voluntary Medical Male Circumcision: An HIV Prevention Priority for PEPFAR. Journal of Acquired Immune Deficiency Syndromes. 2012;60(Suppl 3):S88–S95. 2012-20414-003.
5. Hines JZ, Ntsuape OC, Malaba K, Zegeye T, Serrem K, Odoyo-June E, et al. Scale-Up of Voluntary Medical Male Circumcision Services for HIV Prevention—12 Countries in Southern and Eastern Africa, 2013–2016. MMWR Morbidity And Mortality Weekly Report. 2017;66(47):1285–90. doi: 10.15585/mmwr.mm6647a2 29190263.
6. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR Panorama Spotlight Washington, D.C.: PEPFAR; 2019 [cited 2019 11 June]. Available from: https://data.pepfar.gov/.
7. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Kenya Country Operational Plan (COP/ROP) 2018 Strategic Direction Summary. Washington, D.C.: 2018.
8. Mwandi Z, Murphy A, Reed J, Chesang K, Njeuhmeli E, Agot K, et al. Voluntary medical male circumcision: translating research into the rapid expansion of services in Kenya, 2008–2011. Plos Medicine. 2011;8(11):e1001130–e. doi: 10.1371/journal.pmed.1001130 22140365.
9. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR 2018 Annual Report to Congress. Washington, D.C.: PEPFAR, 2018.
10. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR Country/Regional Operational Plan (COP/ROP) Guidance 2017. Washington, D.C.: U.S. Department of State, 2017 18 January 2017. Report No.
11. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR 2018 Country Operational Plan Guidance for Standard Process Countries. Washington, D.C.: 2018.
12. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR's best practices for voluntary medical male circumcision site operations: A service guide for site operations. 2nd ed. Washington, D.C.: PEPFAR (U.S. President's Emergency Plan for AIDS Relief); 2017.
13. Davis SM, Hines JZ, Habel M, Grund JM, Ridzon R, Baack B, et al. Progress in voluntary medical male circumcision for HIV prevention supported by the US President’s Emergency Plan for AIDS Relief through 2017: longitudinal and recent cross-sectional programme data. BMJ open. 2018;8(8):e021835. doi: 10.1136/bmjopen-2018-021835 30173159
14. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Kenya Country Operational Plan (COP) 2017: Strategic Direction Summary. Washington, D.C.: US Department of Health and Human Services; 2017 21 April 2017. Report No.
15. Kripke K, Opuni M, Odoyo-June E, Onyango M, Young P, Serrem K, et al. Data triangulation to estimate age-specific coverage of voluntary medical male circumcision for HIV prevention in four Kenyan counties. PloS one. 2018;13(12):e0209385. doi: 10.1371/journal.pone.0209385 30562394
16. National AIDS and STI Control Program (NASCOP). National Voluntary Medical Male Circumcision Strategy, 2014/15–2018/19. Nairobi: Government of Kenya, 2015.
17. Rennie S, Muula AS, Westreich D. Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries. Journal Of Medical Ethics. 2007;33(6):357–61. doi: 10.1136/jme.2006.019901 17526688.
18. Luseno WK, Field SH, Iritani BJ, Rennie S, Gilbertson A, Odongo FS, et al. Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya. AIDS and behavior. 2019. doi: 10.1007/s10461-019-02620-7 31375957
19. Friedland BA, Apicella L, Schenk KD, Sheehy M, Hewett PC. How informed are clients who consent? A mixed-method evaluation of comprehension among clients of male circumcision services in Zambia and Swaziland. AIDS And Behavior. 2013;17(6):2269–82. doi: 10.1007/s10461-013-0424-1 23392912.
20. Schenk K, Friedland B, Apicella L, Sheehy M, Munjile K, Hewett P. On the cutting edge: Improving the informed consent process for adolescents in Zambia undergoing male circumcision for HIV prevention. Vulnerable Children and Youth Studies. 2012;7(2):116–27. doi: 10.1016/j.fitote.2016.06.018 PubMed PMID: 27370100.
21. Schenk KD, Friedland BA, Sheehy M, Apicella L, Hewett PC. Making the cut: Evidence-based lessons for improving the informed consent process for voluntary medical male circumcision in Swaziland and Zambia. AIDS Education and Prevention. 2014;26(2):170–84. doi: 10.1521/aeap.2014.26.2.170 2014-13016-007. 24694330
22. Kaufman MR, Dam KH, Van Lith LM, Hatzold K, Mavhu W, Kahabuka C, et al. Voluntary medical male circumcision among adolescents: a missed opportunity for HIV behavioral interventions. AIDS (London, England). 2017;31 Suppl 3:S233–S41. doi: 10.1097/QAD.0000000000001484 28665881.
23. Kaufman MR, Patel EU, Dam KH, Packman ZR, Van Lith LM, Hatzold K, et al. Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision: Moving Toward Age-Equitable Comprehensive Human Immunodeficiency Virus Prevention Measures. Clinical Infectious Diseases. 2018;66:S213–S20. doi: 10.1093/cid/cix952 29617776.
24. Kaufman MR, Patel EU, Dam KH, Packman ZR, Van Lith LM, Hatzold K, et al. Impact of Counseling Received by Adolescents Undergoing Voluntary Medical Male Circumcision on Knowledge and Sexual Intentions. Clinical Infectious Diseases. 2018;66:S221–S8. doi: 10.1093/cid/cix973 29617781.
25. Jennings L, Bertrand J, Rech D, Harvey SA, Hatzold K, Samkange CA, et al. Quality of voluntary medical male circumcision services during scale-up: a comparative process evaluation in Kenya, South Africa, Tanzania and Zimbabwe. Plos One. 2014;9(5):e79524–e. doi: 10.1371/journal.pone.0079524 24801073.
26. University Research Company. Potential Solutions to Common Quality Gaps in VMMC Programs. Maryland: USAID Appying Science to Strengthen and Improve Systems Project, 2017.
27. National AIDS Control Council (NACC) and National AIDS and STIs Control Programme (NASCOP). Kenya HIV Estimates Report 2018. Nairobi: Kenya Ministry of Health, 2018.
28. Muga R, Kizito P, Mbayah M, Gakuruh T. Overview of the health system in Kenya. Kenya service provision assessment (KSPA 2004) survey URL: https://dhsprogram com/pubs/pdf/spa8/02chapter2 pdf [accessed 2018-03-20][WebCite Cache ID 6y3kFHBkt]. 2005.
29. Kimathi L. Challenges of the Devolved Health Sector in Kenya: Teething Problems or Systemic Contradictions? Africa Development. 2017;42(1):55–77.
30. Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health services research. 2007;42(4):1758–72. Epub 2007/02/09. doi: 10.1111/j.1475-6773.2006.00684.x 17286625; PubMed Central PMCID: PMC1955280.
31. VERBI Software. MAXQDA 12. Berlin 2016.
32. Frade S, Rech D, Spyrelis A, Machaku M, Mavhu W, Omondi D, et al. Seasonal patterns in voluntary medical male circumcision (VMMC) in South Africa, Kenya, Tanzania and Zimbabwe. 6th South African AIDS Conference; 18–21 June; Durban2013.
33. Gold E, Mahler H, Boyee D. Overcoming seasonality in scaling up voluntary medical male circumcision. A case study from Tanzania. 2015.
34. Macklin R. On paying money to research subjects: 'due' and 'undue' inducements. IRB: Ethics & Human Research. 1981;3(5):1–6. Epub 1981/05/01. 11649367.
35. Curran K, Njeuhmeli E, Mirelman A, Dickson K, Adamu T, Cherutich P, et al. Voluntary Medical Male Circumcision: Strategies for Meeting the Human Resource Needs of Scale-Up in Southern and Eastern Africa. PLOS Medicine. 2011;8(11):e1001129. doi: 10.1371/journal.pmed.1001129 22140364
36. Government of Kenya National AIDS and STI Control Program (NASCOP). Voluntary Medical Male Circumcision in Kenya: Report of the First Rapid Results Initiative conducted in November/December 2009. Nairobi: NASCOP, 2010 June. Report No.
37. Herman-Roloff A, Bailey RC, Agot K. Factors associated with the safety of voluntary medical male circumcision in Nyanza province, Kenya. Bulletin of the World Health Organization. 2012;90(10):773–81. doi: 10.2471/BLT.12.106112 23109745.
38. Manentsa M, Mukudu H, Koloane N, Ringane A, Matta E, Martinson NA, et al. Complications of high volume circumcision: glans amputation in adolescents; a case report. BMC Urolology. 2019;19(1):65. Epub 2019/07/13. doi: 10.1186/s12894-019-0462-8 31296191; PubMed Central PMCID: PMC6625076.
39. Gray R, Kigozi G, Serwadda D, Makumbi F, Watya, et al. Male circumcision for HIV prevention in men in Rakai, Uganda. Lancet. 2007;369(9562):657–66. doi: 10.1016/S0140-6736(07)60313-4 17321311
40. Bailey R, Moses S, Parker C, Agot K, Maclean I, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet. 2007;369(9562):643–56. doi: 10.1016/S0140-6736(07)60312-2 17321310
41. Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS medicine. 2005;3(5):e226.
42. Gray R, Kigozi G, Kong X, Ssempiija V, Makumbi F, Wattya S, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a posttrial follow-up study. AIDS (London, England). 2012;26(5):609–15. Epub 2012/01/03. doi: 10.1097/QAD.0b013e3283504a3f 22210632; PubMed Central PMCID: PMC4296667.
43. Auvert B, Taljaard D, Rech D, Lissouba P, Singh B, Shabangu D, et al., editors. Effect of the Orange Farm (South Africa) male circumcision roll-out (ANRS-12126) on the spread of HIV. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention; 2011.
44. Riess TH, Achieng MM, Bailey RC. Women's beliefs about male circumcision, HIV prevention, and sexual behaviors in Kisumu, Kenya. PloS one. 2014;9(5):e97748–e. doi: 10.1371/journal.pone.0097748 24844845.
45. Osaki H, Mshana G, Wambura M, Grund J, Neke N, Kuringe E, et al. 'If you are not circumcised, I cannot say yes': The role of women in promoting the uptake of voluntary medical male circumcision in Tanzania. PloS one. 2015;10(9). 2016-03432-001.
46. Kaufman MR, Dam KH, Sharma K, Van Lith LM, Hatzold K, Marcell AV, et al. Females' Peer Influence and Support for Adolescent Males Receiving Voluntary Medical Male Circumcision Services. Clinical Infectious Diseases. 2018;66:S183–S8. doi: 10.1093/cid/cix1057 29617773.
47. Morris BJ, Hankins CA, Banerjee J, Lumbers ER, Mindel A, Klausner JD, et al. Does Male Circumcision Reduce Women's Risk of Sexually Transmitted Infections, Cervical Cancer, and Associated Conditions? Frontiers in Public Health. 2019;7.
48. Njeuhmeli E, Forsythe S, Reed J, Opuni M, Bollinger L, Heard N, et al. Voluntary medical male circumcision: modeling the impact and cost of expanding male circumcision for HIV prevention in eastern and southern Africa. PLoS medicine. 2011;8(11):e1001132. doi: 10.1371/journal.pmed.1001132 22140367
49. Blaizot S, Maman D, Riche B, Mukui I, Kirubi B, Ecochard R, et al. Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya: a modelling study. BMC Infectious Diseases. 2016;16(1):189. doi: 10.1186/s12879-016-1520-4 27129591
50. Hankins C, Warren M, Njeuhmeli E. Voluntary Medical Male Circumcision for HIV Prevention: New Mathematical Models for Strategic Demand Creation Prioritizing Subpopulations by Age and Geography. PloS one. 2016;11(10):e0160699–e. doi: 10.1371/journal.pone.0160699 27783613.
51. Kripke K, Chimbwandira F, Mwandi Z, Matchere F, Schnure M, Reed J, et al. Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography. PloS one. 2016;11(7):1–11. doi: 10.1371/journal.pone.0156521 116789851.
52. Kripke K, Okello V, Maziya V, Benzerga W, Mirira M, Gold E, et al. Voluntary Medical Male Circumcision for HIV Prevention in Swaziland: Modeling the Impact of Age Targeting. PLOS ONE. 2016;11(7):e0156776. doi: 10.1371/journal.pone.0156776 27410687
53. Kripke K, Vazzano A, Kirungi W, Musinguzi J, Opio A, Ssempebwa R, et al. Modeling the Impact of Uganda’s Safe Male Circumcision Program: Implications for Age and Regional Targeting. PloS one. 2016;11(7):e0158693. doi: 10.1371/journal.pone.0158693 27410234
54. McGillen JB, Stover J, Klein DJ, Xaba S, Ncube G, Mhangara M, et al. The emerging health impact of voluntary medical male circumcision in Zimbabwe: An evaluation using three epidemiological models. PloS one. 2018;13(7):e0199453. doi: 10.1371/journal.pone.0199453 30020940
55. de Kok BC, Widdicombe S, Pilnick A, Laurier E. Doing patient-centredness versus achieving public health targets: A critical review of interactional dilemmas in ART adherence support. Social Science & Medicine. 2018;205:17–25. https://doi.org/10.1016/j.socscimed.2018.03.030.
56. Joint United Nations Programme on HIV/AIDS (UNAIDS). Safe, Voluntary, Informed Male Circumcision and Comprehensive HIV Prevention Programming: Guidance for decision-makers on human rights, ethical and legal considerations. Geneva: UNAIDS, 2008 June 2007. Report No.
57. U.S. President's Emergency Plan for AIDS Relief (PEPFAR). PEPFAR best practices for voluntary medical male circumcision site operations: A service guide for site operations. PEPFAR Washington, DC; 2013.
58. Feldacker C, Makunike-Chikwinya B, Holec M, Bochner AF, Stepaniak A, Nyanga R, et al. Implementing voluntary medical male circumcision using an innovative, integrated, health systems approach: experiences from 21 districts in Zimbabwe. Global health action. 2018;11(1):1414997–. doi: 10.1080/16549716.2017.1414997 29322867.
59. Feldacker C, Bochner AF, Herman-Roloff A, Holec M, Murenje V, Stepaniak A, et al. Is it all about the money? A qualitative exploration of the effects of performance-based financial incentives on Zimbabwe's voluntary male medical circumcision program. PloS one. 2017;12(3):1–15. doi: 10.1371/journal.pone.0174047 121877066.
60. Masukume G. The ethics of claiming a 60% reduction in HIV acquisition from voluntary medical male circumcision. South African Journal of Bioethics and Law. 2014;7(1):4–.
61. Green LW, Travis JW, McAllister RG, Peterson KW, Vardanyan AN, Craig A. Male circumcision and HIV prevention: Insufficient evidence and neglected external validity. American journal of preventive medicine. 2010;39(5):479–82. doi: 10.1016/j.amepre.2010.07.010 20965388
62. Gwandure C. The ethical concerns of using medical male circumcision in HIV prevention in Sub-Saharan Africa. South African Journal of Bioethics and Law. 2011;4(2):89–94.
63. Van Howe RS, Storms MR. How the circumcision solution in Africa will increase HIV infections. Journal of public health in Africa. 2011;2(1):e4–e. doi: 10.4081/jphia.2011.e4 28299046.
64. Svoboda JS, Adler PW, Van Howe RS. Circumcision Is Unethical and Unlawful. The Journal Of Law, Medicine & Ethics: A Journal Of The American Society Of Law, Medicine & Ethics. 2016;44(2):263–82. doi: 10.1177/1073110516654120 27338602.
65. Sgaier SK, Reed JB, Thomas A, Njeuhmeli E. Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs. PLoS medicine. 2014;11(5):e1001641. doi: 10.1371/journal.pmed.1001641 24800840
66. Morris BJ, Wamai RG, Henebeng EB, Tobian AA, Klausner JD, Banerjee J, et al. Estimation of country-specific and global prevalence of male circumcision. Population Health Metrics. 2016;14(1):4. doi: 10.1186/s12963-016-0073-5 26933388
67. Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G. Male circumcision: global trends and determinants of prevalence, safety and acceptability. World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS). 2007.
68. Owings M, Uddin S, Williams S. Trends in circumcision for male newborns in US hospitals. NCHS health notes: Citeseer; 2013.
69. Morris BJ, Bailis SA, Wiswell TE, editors. Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have? Mayo Clinic Proceedings; 2014: Elsevier.
70. Mor Z, Kent CK, Kohn RP, Klausner JD. Declining Rates in Male Circumcision amidst Increasing Evidence of its Public Health Benefit. PloS one. 2007;2(9):e861. doi: 10.1371/journal.pone.0000861 17848992
71. Bonham VH, Morenso JD. Research with captive populations: Prisoners, students, and soldiers. In: Emanuel EJ, Grady CC, Crouch RA, Lie RK, Miller FG, Wendler DD, editors. The Oxford Handbook of Clinical Research Ethics. Oxford: Oxford University Press; 2008.
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