Tag Archive for: Uganda

Posts

Article of the Month: HIV no barrier to circumcision

Every week the Editor-in-Chief selects the Article of the Week from the current issue of BJUI. The abstract is reproduced below and you can click on the button to read the full article, which is freely available to all readers for at least 30 days from the time of this post. 

In addition to the article itself, there is an accompanying editorial written by prominent members of the urological community. This blog is intended to provoke comment and discussion and we invite you to use the comment tools at the bottom of each post to join the conversation.

This month our lead article on HIV and circumcision comes from Uganda. The front cover of January’s issue shows the Nile at Lake Victoria in Uganda. If you only have time to read one article this week, it should be this one.

Male circumcision wound healing in human immunodeficiency virus (HIV)-negative and HIV-positive men in Rakai, Uganda

Godfrey Kigozi*, Richard Musoke*, Nehemiah Kighoma*, Stephen Watya*, David Serwadda*, Fred Nalugoda*, Noah Kiwanuka‡, James Nkale*, Fred Wabwire-Mangen, Frederick Makumbi*, Nelson K. Sewankambo§, Ronald H. Gray* and Maria J. Wawer*

*Rakai Health Sciences Program, Entebbe, Urocare, School of Public Health, Makerere University, and §College of Health Sciences, Makerere University, Kampala, Uganda, and ¶Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA

OBJECTIVE

• To assess completed wound healing after medical male circumcision (MMC) among human immunodeficiency virus (HIV)-negative and HIV-positive men with cluster of differentiation 4 (CD4) counts of <350 and ≥350 cells/mm3, as minimal data are available on the safety of MMC among HIV-positive men with low CD4 counts.

PATIENTS AND METHODS

• In all, 262 HIV-negative and 177 HIV-positive consenting males aged ≥12 years accepted MMC using the dorsal slit procedure and were enrolled in the study.

• Socio-demographic and behavioural data and blood for HIV testing and CD4 counts were collected at baseline.

• Participants were followed weekly to collect information on resumption of sex, condom use and both self-reported and clinically assessed wound healing.

• The proportions healed among HIV-positive men were compared with HIV-negative men. Time to complete wound healing was assessed by Kaplan–Meier survival analysis.

RESULTS

• There were no statistically significant differences in the proportion of men healed by HIV status.

• At 4 weeks, the proportions healed were 85.9% in HIV-negative men, 77.4% in HIV-positive men with a CD4 count of ≥350 cells/mm3and 87.1% in HIV-positive men with a CD4 count of <350 cells/mm3.

• The median time to healing was 4 weeks and did not vary by HIV or CD4 status.

• All men had certified complete wound healing at 6 weeks after MMC. In all, 1.4% of HIV-positive men with a CD4 count of <350 cells/mm3 resumed sex before healing, compared with 8.5% among HIV-positive men with a CD4 count of ≥350 cells/mm3 (P = 0.052) and 7.8% (P = 0.081) among HIV-negative men.

CONCLUSION

• Inclusion of HIV-positive men with low CD4 counts in MMC services is not deleterious to postoperative wound healing.

 

Read Previous Articles of the Week

 

Editorial: Circumcision – follow-up or not?

There is an excellent study from Uganda in this issue of the BJUI [1]. It looks at the rate of healing of men undergoing prophylactic circumcision. Some had HIV; others not. What they termed ‘complete wound healing’ was an intact scar without a scab, sutures or a sinus – effectively a ‘sealed’ wound. There are several useful data therein:

  • all men had healed by 6 weeks; the median being 4 weeks.
  • HIV status did not appear to delay wound healing, even with low CD4 counts.
  • the patient was 95% likely to judge wound healing correctly himself.
  • routine circumcision can be safely carried out by trained medical officers.
  • a complication rate of 0.5% was reported.

So what follow-up, if any, is necessary after circumcision? Based on this population it would appear that a well instructed/consented patient can be relied on to judge healing after prophylactic circumcision. They probably do not need follow-up provided their expectations are managed well, and there is ease of access to return should problems arise.

However, this may not be generalizable to men having circumcision for phimosis or other abnormality of foreskin. These patients may have delayed healing, meatal issues or a urethral stricture upstream. Histopathological examination of abnormal foreskins is sensible also as further treatment/follow-up may indicated.

I recommend a read of this superb paper.

Paul K. Hegarty
Consultant Urological Surgeon, Mater Private, Cork, Ireland

© 2020 BJU International. All Rights Reserved.