Open AccessAdverse events in a large‐scale VMMC programme in Tanzania: findings from a case series analysis
Author(s) -
Hellar Augustino,
Plotkin Marya,
Lija Gissenge,
Mwanamsangu Amasha,
Mkungume Saidi,
Christensen Alice,
Mushi Jeremiah,
Machaku Michael,
Maokola Thomas,
Mlanga Eric,
Curran Kelly
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25369
Subject(s) - medicine , tanzania , adverse effect , scale (ratio) , series (stratigraphy) , pharmacology , socioeconomics , physics , quantum mechanics , sociology , paleontology , biology
Adverse events ( AE s) rates in voluntary medical male circumcision ( VMMC ) are critical measures of service quality and safety. While these indicators are key, monitoring AE s in large‐scale VMMC programmes is not without challenges. This study presents findings on AE s that occurred in eight years of providing VMMC services in three regions of Tanzania, to provide discussion both on these events and the structural issues around maintaining safety and quality in scaled‐up VMMC services. Methods We look at trends over time, demographic characteristics, model of VMMC and type and timing of AE s for 1307 males who experienced AE s among all males circumcised in Tabora, Njombe and Iringa regions from 2009 to 2017. We analysed deidentified client data from a VMMC programme database and performed multivariable logistic regression with district clustering to determine factors associated with intraoperative and postoperative AE s among VMMC clients. Results and discussion Among 741,146 VMMC clients, 0.18% (1307/741,146) experienced a moderate or severe AE . The intraoperative AE rate was 2.02 per 100,000 clients, and postoperative rate was 2.29 per 1000 return clients. Multivariable logistic regression showed that older age (20 to 29 years) was significantly associated with intraoperative AE s ( aOR : 3.51, 95% CI : 1.17 to 10.6). There was no statistical significant difference in AE rates by surgical method. Mobile VMMC service delivery was associated with the lowest risk of experiencing postoperative AE s ( aOR :0.64, 95% CI : 0.42 to 0.98). AE rates peaked in the first one to three years of the programme and then steadily declined. Conclusions In a programme with robust AE monitoring methodologies, AE rates reported in these three regions were very low and declined over time. While these findings support the safety of VMMC services, challenges in reporting of AE s in a large‐scale VMMC programme are acknowledged. International and national standards of AE reporting in VMMC programmes are clear. As VMMC programmes transition to national ownership, challenges, strengths and learning from AE reporting systems are needed to support safety and quality of services.