Safety of task-shifting for male medical circumcision: a systematic review and meta-analysis

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Introduction:Task-shifting for male medical circumcision is proposed as a strategy to overcome the lack of surgeons and doctors in high HIV prevalence settings. We undertook a systematic review and meta-analysis to review the safety of task-shifting for circumcision in Africa.Methods:We searched online databases and conference websites up to July 2011 without language restriction for studies reporting outcomes of task-shifting for circumcision in Africa. Information was extracted independently and in duplicate on study characteristics, quality, and outcome data. Case reports and case series were excluded.Results:Ten studies met our inclusion criteria, providing outcome data on 25 119 circumcisions. The proportion of adverse events ranged from 0.70 [95% confidence interval (CI) 0.44–1.02%] to 37.36% (95% CI 27.54–47.72%), with an overall pooled proportion of 2.31% (95% CI 1.46–3.16%; τ2 = 1.21; P < 0.001). Two studies reported outcomes separately for both doctors and non-physicians; there was no difference in the risk of adverse events by provider (pooled relative risk 1.18; 95% CI 0.78–1.78). The frequency of excessive bleeding ranged from 0.30 (0.09–0.65%) to 24.71% (16.27–34.26%) with an overall pooled prevalence of 0.55% (95% CI 0.13–0.97%). Infection occurred in 0.30 (0.14–1.47%) to 1.85% (0.07–5.96%) of cases, with an overall pooled proportion of 0.88% (95% CI 0.29–1.47%). All adverse events were reported to be non-severe.Conclusion:Task-shifting of male medical circumcision to non-physician clinicians can be done safely, with reported rates of adverse events similar to doctors and specialists.

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