ArticlePloS one2014
Surgical efficiencies and quality in the performance of voluntary medical male circumcision (VMMC) procedures in Kenya, South Africa, Tanzania, and Zimbabwe.
Article in PloS one, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06273696 (Evaluation of the Acceptability and Safety of the ShangRing Device for Male Circumcision in Shinyanga, Tanzania), which is not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluation of the Acceptability and Safety of the ShangRing Device for Male Circumcision in Shinyanga, Tanzania
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review.Health policy and planning · 2023Pooled it
- The cost-effectiveness of three methods of disseminating information to improve medical male circumcision in Uganda.PloS one · 2018Trial
- Monitoring and evaluation strategies for surgical task-shifting and task-sharing interventions: a scoping review.Human resources for health · 2026Article
- Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis.BMC health services research · 2023Article
- The voluntary medical male circumcision Site Capacity and Productivity Assessment Tool (SCPT): An innovative visual management tool to optimize site service delivery.PLOS global public health · 2022Article
- Adverse events in a large-scale VMMC programme in Tanzania: findings from a case series analysis.Journal of the International AIDS Society · 2019Article
- Article
- Delivering PrePex Medical Male Circumcision Services Through a Mobile Clinic: The Experience From a Pilot Project in North West Province, South Africa.Journal of acquired immune deficiency syndromes (1999) · 2016Article
- Voluntary medical male circumcision in resource-constrained settings.Nature reviews. Urology · 2015Review
- Toward a Systematic Approach to Generating Demand for Voluntary Medical Male Circumcision: Insights and Results From Field Studies.Global health, science and practice · 2015Review
- Article
- Advancing the strategic use of HIV operations research to strengthen local policies and programmes: the Research to Prevention Project.Journal of the International AIDS Society · 2015Article
- Voluntary medical male circumcision scale-up in Nyanza, Kenya: evaluating technical efficiency and productivity of service delivery.PloS one · 2015Article
- Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.PLoS medicine · 2014Article
- Cost drivers for voluntary medical male circumcision using primary source data from sub-Saharan Africa.PloS one · 2014Article
- Implications of the fast-evolving scale-up of adult voluntary medical male circumcision for quality of services in South Africa.PloS one · 2014Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
introductionThis analysis explores the association between elements of surgical efficiency in voluntary medical male circumcision (VMMC), quality of surgical technique, and the amount of time required to conduct VMMC procedures in actual field settings. Efficiency outcomes are defined in terms of the primary provider's time with the client (PPTC) and total elapsed operating time (TEOT).
methodsTwo serial cross-sectional surveys of VMMC sites were conducted in Kenya, Republic of South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed quality of surgical technique and timed 9 steps in the VMMC procedure. Four elements of efficiency (task-shifting, task-sharing [of suturing], rotation among multiple surgical beds, and use of electrocautery) and quality of surgical technique were assessed as explanatory variables. Mann Whitney and Kruskal Wallis tests were used in the bivariate analysis and linear regression models for the multivariate analyses to test the relationship between these five explanatory variables and two outcomes: PPTC and TEOT. The VMMC procedure TEOT and PPTC averaged 23-25 minutes and 6-15 minutes, respectively, across the four countries and two years. The data showed time savings from task-sharing in suturing and use of electrocautery in South Africa and Zimbabwe (where task-shifting is not authorized). After adjusting for confounders, results demonstrated that having a secondary provider complete suturing and use of electrocautery reduced PPTC. Factors related to TEOT varied by country and year, but task-sharing of suturing and/or electrocautery were significant in two countries. Quality of surgical technique was not significantly related to PPTC or TEOT, except for South Africa in 2012 where higher quality was associated with lower TEOT.
conclusionsSYMMACS data confirm the efficiency benefits of task-sharing of suturing and use of electrocautery for decreasing TEOT. Reduced TEOT and PPTC in high volume setting did not result in decreased quality of surgical care.
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