Page 147 - HIVMED_v21_i1.indb

Page 2 of 8 Original Research

Studies exploring reasons for men’s unwillingness to be Data collection procedures
circumcised have identified concerns related to potential After circumcision, follow-up visits were scheduled in
effects of VMMC on sexual function (e.g. erection and alignment with the Botswana MOH guidelines for adult
orgasm) and sexual pleasure, the risk of surgical pain, VMMC (2 days, 7 days, 6 weeks, 3 months and 1 year). At
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reluctance to abstain from sex for at least 6 weeks during
recovery and partners’ responses. 11,12,13 A systematic review study visits, participants were asked to self-administer a
that included > 40 000 men from cross-sectional, case-control questionnaire about wound care, patient satisfaction of the
and pre-post circumcision studies concluded that VMMC procedure and resumption of sexual activities. At 3 months,
likely has little or no effect on male sexual function and questionnaire items included assessment of sexual functions.
satisfaction. However, ascertainment of sexual function Each study participant was provided with a wallet-size
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data and findings varied across African settings 15,16,17 and reminder card noting the date of each follow-up visit. Prior to
almost no data were included from the context of national each visit, study staff telephoned participants to remind them
VMMC programmes under ‘real-world’ conditions. One of the upcoming scheduled appointment. At each follow-up
population-based cohort study in Kenya has found that the visit, study staff performed a physical examination, including
majority of the men who undergo VMMC are satisfied with inspecting the circumcision site, and assessing for signs of
the procedure and experience improvement in sexual sexually transmitted infections (STIs). Participants received
function that increased over time. To date, no evaluations BWP100 (approximately USD$8 at study initiation) at each
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have examined sexual function amongst the men who visit as reimbursement for time and travel costs. In the event
undergo VMMC in Botswana, nor their perceptions of post- of a missed visit, study staff made telephone calls to
VMMC satisfaction beyond 7 days. Gathering evidence on reschedule the appointment.
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these elements within the local context could inform VMMC
messaging tailored to Botswana. Statistical analysis
The current analysis on sexual function and satisfaction with
We previously assessed the frequency of adverse events at 7 the VMMC procedure at 3 months was restricted to men who
days and early resumption of sexual intercourse amongst had data available from 3-month follow-up visits, as data on
a cohort of adult men who underwent VMMC within earlier outcomes from this cohort had previously been
a programmatic delivery setting in Botswana. 19,20 This current reported. We identified differences between men with and
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analysis examines the post-VMMC experience at 3 months, without data on sexual function available at 3-month post-
including sexual function and satisfaction with the procedure. VMMC using Chi-square tests for proportions and Kruskal–
Given the suboptimal uptake of VMMC in Botswana and the
concerns of its potentially negative impact on sexual function Wallis test for continuous measures. We assessed satisfaction
identified in qualitative studies, 21,22 these new data could with the VMMC procedure and the follow-up care using a
provide valuable evidence for VMMC demand-creation four-point Likert scale (very satisfied, somewhat satisfied,
messaging in Botswana. somewhat dissatisfied and very dissatisfied). We compared
the frequency distributions of satisfaction at 7-day and
Methods 3-month post-VMMC amongst men who had data available
from both time points to describe the changes in satisfaction
Study design and participants with the VMMC procedure over time. We assessed whether
We analysed data from a cohort study comprising HIV- categories of sexual function improved, had no change or
negative, sexually active men aged 18–49 years who worsened, compared to before undergoing VMMC using a
underwent VMMC through Botswana’s National Safe Male three-point Likert scale (better, no change and worse).
Circumcision programme at two government-run clinics in Domains of sexual function included sexual desire, ability to
Gaborone, Botswana. Between November 2013 and April put on a condom, ease of vaginal penetration, ease of
2015, the parent study enrolled men to prospectively assess ejaculation, ability to achieve and maintain an erection, and
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sexual behaviours and adverse events following VMMC. hygiene/cleanliness. Descriptive statistics were used to
Parent study procedures have been described previously in summarise the frequency distributions of each sexual
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detail. Briefly, the study was collaboratively conducted by function category.
the Botswana Ministry of Health (MOH) and the International
Training and Education Center for Health (I-TECH), a We evaluated the following enrolment characteristics
collaboration between the University of Washington and the as potential predictors of reporting any worsened
University of California, San Francisco. After individuals sexual function: demographic information (age, education,
completed group education about the risks and benefits of relationship status, employment, electricity in household) and
VMMC and received individual counselling from clinic staff behaviour (alcohol consumption, age of sexual debut, number
(including HIV testing), they were screened for eligibility and sexual partners [lifetime, last 12 months], type of most recent
offered enrolment into the study. Study staff collected relationship [regular or casual], history of buying sex and
information on demographic, clinical, relationship and sexual condom use) and primary motivation for VMMC (HIV
behaviour characteristics at enrolment. All clinical VMMC prevention vs. other reasons). Variables were identified as
activities were conducted per MOH guidelines at no cost to predictors using univariate Poisson regression models with
participants and were not part of the study procedures. 23 robust error variance, an approach used when the outcome

http://www.sajhivmed.org.za 139 Open Access