Manual for Male Circumcision under Local Anaesthesia

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Male circumcision under local anaesthesia Version 3.1(Dec09) Surgical hand scrub 8-7 Personal protective equipment 8-7 Gloves 8-7 Masks, caps and protective eyewear 8-8 Aprons and the surgeon’s gown 8-9 Footwear 8-9 Immunizations 8-9 Safe handling of hypodermic needles and syringes 8-10 Tips for safe use of hypodermic needles and syringes 8-10 Sharps containers 8-10 Processing of instruments, environmental cleaning and management of spills 8-11 Disinfection 8-11 Cleaning 8-12 High-level disinfection 8-12 Sterilization 8-12 Environmental cleaning 8-13 Management of spills 8-13 Safe disposal of infectious waste materials 8-14 Waste management 8-14 Tips for safe handling and disposal of infectious waste 8-14 Disposing of sharp items 8-14 Burning waste containers 8-15 Encapsulating waste containers 8-15 Burying waste 8-15 Post-exposure prophylaxis 8-16 Managing occupational exposure to hepatitis B, hepatitis C and HIV 8-16 Management of exposure to hepatitis B 8-16 Management of exposure to hepatitis C 8-17 Post-exposure prophylaxis for HIV 8-18 Clinic staff should know their HIV status 8-21 9. Managing a circumcision service Summary 9-1 Record keeping, monitoring and evaluation 9-1 Indicators 9-1 What is monitoring 9-2 What is evaluation 9-2 Why evaluate male circumcision programmes 9-2 What is a monitoring system 9-2 Monitoring performance in male circumcision programs 9-3 Evaluation 9-3 What are “good data” 9-4 Quality assurance 9-4 Supervision 9-5 The goal 9-6 The style 9-6 The process 9-6 Appendix 9.1: Sample stock card 9-9 Appendix 9.2: Sample stock-taking card for consumables 9-10 Appendix 9.3: Sample male circumcision adverse event form 9-11 Appendix 9.4: Sample male circumcision register 9-15 Page vi
Male circumcision under local anaesthesia Version 3.1(Dec09) PREFACE Male circumcision has been performed on boys and young men for many years, primarily for religious and cultural reasons or as a rite of passage to mark the transition to adulthood. Data from cross-sectional epidemiological studies conducted since the mid-1980s showed that circumcised men have a lower prevalence of HIV infection than uncircumcised men. This finding was supported by data from prospective studies that showed a lower incidence of HIV infection in circumcised men than in uncircumcised men. Although the analysis adjusted for cultural and social factors associated with male circumcision, it was not clear from these studies whether promoting male circumcision among men who would not otherwise be circumcised would result in a lower incidence of HIV infection. To address this question, three randomized controlled trials were launched in Kenya, Uganda and South Africa in 2004. The results from the South African study were published in late 2005, and showed a 60% lower incidence of HIV infection among men randomly assigned to undergo immediate circumcision compared with those assigned to delayed circumcision. Confirmatory results from the two other trials were released in December 2006. These data led WHO and UNAIDS to recommend in 2007 that male circumcision should be considered an additional way of reducing risk of HIV infection in men and programmes for safe male circumcision should be expanded rapidly in countries and settings with generalized HIV epidemics and low prevalence of circumcision. There is increased demand for male circumcision in several countries with a high incidence of HIV, but there is little technical guidance on how services can be safely expanded given the limited resources available. Reports of high complication rates following circumcisions performed on young men by traditional circumcisers in southern and eastern Africa are common, but the true incidence is not known. Technical guidance on the provision of safe male circumcision services is therefore necessary. Although circumcisions are widely performed by surgeons and general practitioners in an appropriate clinical environment, resources are not currently adequate to meet the anticipated increased demand. This technical manual on male circumcision is aimed at providers of male circumcision services and programme managers. No attempt is made to describe all possible methods for male circumcision. The methods covered have been selected on the basis of their safety and practicality for use in resource-limited settings. The manual forms part of a comprehensive package, which includes training guides and materials, as well as a male circumcision quality improvement framework for use by providers, programme managers and national medical authorities to ensure high-quality services. While providing detailed technical information on the different surgical approaches, the manual also addresses broader issues of sexual and reproductive health of men, and emphasizes that male circumcision must be set within the context of other strategies for reducing risk of HIV infection. A full description of best practices for surgery and anaesthesia in resource-limited settings can be found in the WHO publication, Surgical care at the district hospital (Geneva, WHO, 2003). The manual has been developed by the World Health Organization (WHO), in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Jhpiego, as part of work to support countries in providing safe male circumcision services, and ensuring that circumcised men do not perceive themselves as fully protected against HIV and other sexually transmitted infections and consequently forgo other HIV risk-reduction strategies. The manual was developed from reproductive health and surgery training materials, as well as on the basis of experience with service provision in Africa, the Eastern Mediterranean, Page vii
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Manual for Male Circumcision under Local Anaesthesia

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