What device would be best for early infant male circumcision in east and southern Africa? Provider experiences and opinions with three different devices in Kenya.
What device would be best for early infant male circumcision in east and southern Africa? Provider experiences and opinions with three different devices in Kenya.
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DOI：
10.1371/journal.pone.0171445
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Otieno FO
中科院分区：
文献类型：
--
作者：
Bailey RC;Nyaboke I;Otieno FO
自愿医疗男性包皮环切术（VMMC）将异性恋男性感染艾滋病毒的风险降低了约60%。随着一些国家接近青少年和成年人包皮环切比例的目标，一些国家正在考虑将早期婴儿男性包皮环切术作为实现VMMC可持续性的手段，以长期降低艾滋病毒发病率。对EIMC专用设备的评估对于为项目提供所需信息以做出关于如何设计安全、有效的EIMC项目的明智决策非常重要。我们由11家在肯尼亚拥有经验的供应商提供评估，这些供应商采用了东非和南部非洲各种EIMC计划最有可能考虑的所有三种设备。没有一种设备被认为明显上级其他设备。每一种都有自己的优点和缺点。供应商的偏好是具体情况。如果他们自己进行手术，最喜欢Mogen夹。然而，大多数人担心，并非每个人都具备最佳安全所需的技能。如果其他人正在为儿子进行包皮环切术，大多数人会选择AccuCirc，因为使用Mogen时存在切断阴茎头的风险。少数人更喜欢PrePex，但只有在婴儿接受局部麻醉时，而不是制造商目前规定的EMLA乳膏（2.5%利多卡因和2.5%丙胺卡因的低共熔混合物）。在国家EIMC项目的背景下，所有参与者都同意AccuCirc是他们推荐的器械，因为AccuCirc可以保护龟头免受撕裂，并且提供了预组装的无菌套件，可以克服额外供应或高压灭菌的需求。所有人都同意，扩大EIMC，将其与现有的孕产妇儿童健康服务相结合，将面临重大挑战，其中最重要的是说服已经负担过重的提供者承担额外的工作量。这些结果将是有益的程序员考虑在撒哈拉以南非洲地区的环境中引入EIMC服务。
Voluntary medical male circumcision (VMMC) reduces risk of HIV acquisition in heterosexual men by approximately 60%. As some countries approach targets for proportions of adolescents and adults circumcised, some are considering early infant male circumcision (EIMC) as a means to achieve sustainability of VMMC for long term reduction of HIV incidence. Evaluations of specialized devices for EIMC are important to provide programs with information required to make informed decisions about how to design safe, effective EIMC programs. We provide assessments by 11 providers with experience in Kenya employing all three of the devices most likely to be considered by various EIMC programs in east and Southern Africa. There was no one device that was seen to be clearly superior to the others. Each had its own advantages and disadvantages. Provider preferences were situation-specific. Most preferred the Mogen Clamp if they themselves were performing the procedure. However, most were concerned that not everyone will have the skills necessary for optimal safety. If someone else were circumcising their son, most would opt for the AccuCirc because of the risk of severing the glans when using the Mogen. A minority preferred the PrePex, but only if the baby received local anesthesia, not EMLA cream (a eutectic mixture of lidocaine 2.5% and prilocaine 2.5%), as presently prescribed by the manufacturer. In the context of a national EIMC program, all participants agreed that AccuCirc would be the device they would recommend due to protection of the glans from laceration and to the provision of a pre-assembled sterile kit that overcomes the need for additional supplies or autoclaving. All agreed that scaling up EIMC, integrating it with existing maternal child health services, will face significant challenges, not least of which is persuading already over-burdened providers to take on additional workload. These results will be useful to programmers considering introduction of EIMC services in sub-Saharan African settings.