Implementation and Operational Research: Evaluation of Loss-to-Follow-up and Postoperative Adverse Events in a Voluntary Medical Male Circumcision Program in Nyanza Province, Kenya.
BACKGROUND
More than 4.7 million voluntary medical male circumcisions (VMMCs) had been provided by HIV prevention programs in sub-Saharan Africa through 2013. All VMMC clients are recommended to return to the clinic for postoperative follow-up, although adherence is variable. The clinical status of clients who do not return is largely unknown.


METHODS
VMMC clients from Nyanza Province, Kenya, aged older than or equal to 13 years, were recruited immediately after surgery from April to October 2012 from high-volume sites. Medical record reviews at 13-14 days after surgery indicated which clients had been adherent with recommended follow-up (ADFU) and which were lost-to-follow-up (LTFU). Clients in the LTFU group received clinical evaluations at home approximately 2 weeks postsurgery. Adverse events (AEs) and AE rates were compared between the ADFU and LTFU groups.


RESULTS
Of 4504 males approached in 50 VMMC sites, 1699 (37.7%) were eligible and enrolled and 1600 of 1699 (94.2%) contributed to follow-up and AE data. Medical record review indicated 897 of 1600 (56.1%) were LTFU, and 762 (84.9%) of these received home-based clinical evaluations. The rate of moderate or severe AE diagnosis was 6.8% in the LTFU group vs. 3.3% in the ADFU group (relative risk = 2.1, 95% confidence interval: 1.3 to 3.4).


CONCLUSIONS
The moderate or severe AE diagnosis rate was approximately 2 times higher in the LTFU group. National programs should consider instituting surveillance systems to detect AEs that might otherwise go unnoticed. Providers should emphasize the importance of follow-up and actively contact LTFU clients to ensure care is provided throughout the entire postoperative course for all.
*Division of Global HIV AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA; †Division of Global HIV AIDS, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya; ‡ICAP, Columbia University, New York, NY; and §National AIDS and Sexually Transmitted Infection Control Programme, Ministry of Health, Nairobi, Kenya.
Jason Bailey
JB
Reed
Jonathan
J
Grund
Yang
Y
Liu
Zebedee
Z
Mwandi
Andrea A
AA
Howard
Margaret L
ML
McNairy
Kipruto
K
Chesang
Peter
P
Cherutich
Naomi
N
Bock
D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects*; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007630:Kenya; D059012:Lost to Follow-Up; D008297:Male; D009313:National Health Programs; D011183:Postoperative Complications / Q000453:epidemiology; D055815:Young Adult