ArticlePloS one2018
The quality of voluntary medical male circumcision done by mid-level workers in Tshwane District, South Africa: A retrospective analysis.
Article in PloS one, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
11 citing papers in PubMed, 3 syntheses or guidelines pooled it, 21 citations in OpenAlex.
- Assessing the impact of anaesthetic and surgical task-shifting globally: a systematic literature review.Health policy and planning · 2023Pooled it
- Systematic review: Safety of surgical male circumcision in context of HIV prevention public health programmes.Gates open research · 2022Pooled it
- The cost-effectiveness of physician assistants/associates: A systematic review of international evidence.PloS one · 2021Pooled it
- Trial
- Deficits and opportunities, pivots and shifts for scaling-up voluntary medical male circumcision in Uganda: a qualitative reflexive thematic analysis study.BMC public health · 2024Article
- The role of clinical associates in South Africa as a health workforce: A scoping review.African journal of primary health care & family medicine · 2024Article
- Stakeholders' views on the utility and employment strategies of clinical associates.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2022Article
- Clinical associates and access to healthcare in the Eastern Cape province of South Africa.African journal of primary health care & family medicine · 2022Article
- Barriers to surgery performed by non-physician clinicians in sub-Saharan Africa-a scoping review.Human resources for health · 2020Article
- Cost and cost-effectiveness of voluntary medical male circumcision in street-connected youth: findings from an education-based pilot intervention in Eldoret, Kenya.AIDS research and therapy · 2018Article
- Reliability of thermocautery-assisted circumcision: retrospective analysis of circumcision performed voluntarily in countries of low socioeconomic status.Therapeutic advances in urologyArticle
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundVoluntary medical male circumcision (VMMC) reduces the acquisition of human immunodeficiency virus (HIV) in heterosexual men by up to 60%. One HIV infection is averted for every 5 to 15 VMMCs. To conduct VMMCs in large populations, large numbers of trained healthcare professionals are needed. Countries in Sub-Saharan Africa have a high burden of HIV and a shortage of healthcare professionals, creating a healthcare conundrum. To bridge this gap, South Africa launched a new cadre of mid-level medical worker called Clinical Associates (CA). We assessed the ability of CAs to perform circumcisions of adequate quality and their subsequent usefulness to meet the demands of VMMCs in a population with a high HIV burden.
methodsWe conducted a retrospective analysis, reviewing patient files (n = 4850) of surgical VMMCs conducted over a 16-month period. Patient files were sourced from clinics and hospitals that provided free VMMCs in Tshwane district in South Africa.
findingsClinical associates performed 88.66% of the circumcisions and doctors performed the remaining 11.34% (p < 0.001). The number of adverse events did not differ between the two groups. Data on intra-operative adverse events were available for 4 738 patients. Of these, 341 (7.2%) experienced intra-operative adverse events. For the whole sample, 44 (8.1%, n = 543) adverse events occurred during circumcisions done by doctors and 297 (7.1%, n = 4195) occurred during circumcisions done by CAs (p = 0.385). Clinical associates performed circumcisions in shorter times (duration: 14.63 minutes) compared to doctors (duration: 15.25 minutes, t = -7.46; p < 0.001). Recorded pain, bleeding, swelling, infection and wound destruction did not differ between clients circumcised by CAs and doctors. This study is limited by the use of data from a single district.
conclusionsClinical associates contribute to the demands for high numbers of VMMCs in Tshwane district, South Africa. Clinical associates perform VMMCs at a clinical standard that is comparable to circumcisions performed by doctors.
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