{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T01:57:34Z","timestamp":1768615054161,"version":"3.49.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T00:00:00Z","timestamp":1667865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Curr HIV\/AIDS Rep"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose of Review<\/jats:title>\n                <jats:p>Through December 2020, the U.S. President\u2019s Emergency Plan for AIDS Relief (PEPFAR) supported more than 25 million voluntary medical male circumcisions (VMMC) as part of the combined HIV prevention strategy in 15 African countries. PEPFAR monitors defined adverse events (AEs) occurring within 30\u00a0days of VMMC through its notifiable adverse event reporting system (NAERS). All NAERS reports through December 2020 were reviewed to quantify AE type, severity, and relation to the VMMC procedure. Interventions to improve client safety based on NAERS findings are described.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Recent Findings<\/jats:title>\n                <jats:p>Fourteen countries reported 446 clients with notifiable adverse events (NAEs); 394\/446 (88%) were determined VMMC-related, representing approximately 18 NAE reports per million circumcisions. Fatalities comprised 56\/446 (13%) with 24\/56 (43%) of fatalities determined VMMC-related, representing 0.96 VMMC-related fatalities per million circumcisions. The remaining 390 NAEs were non-fatal with 370\/390 (95%) VMMC-related. Multiple programmatic changes have been made based on NAERS data to improve client safety.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Summary<\/jats:title>\n                <jats:p>Client safety is paramount in this surgical program designed for individual and population-level benefit. Surveillance of rare but severe complications following circumcision has identified pre-existing or new safety concerns and guided continuous programmatic improvement.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11904-022-00636-8","type":"journal-article","created":{"date-parts":[[2022,11,8]],"date-time":"2022-11-08T17:16:56Z","timestamp":1667927816000},"page":"508-515","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Consolidated Overview of Notifiable Adverse Events in the U.S. President\u2019s Emergency Plan for AIDS Relief\u2019s Voluntary Medical Male Circumcision Program Through 2020"],"prefix":"10.1007","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8785-1830","authenticated-orcid":false,"given":"Todd","family":"Lucas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Cooney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amber","family":"Prainito","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Godfrey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerian","family":"Kiggundu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne Goldzier","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renee","family":"Ridzon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Toledo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,11,8]]},"reference":[{"issue":"11","key":"636_CR1","doi-asserted-by":"publisher","first-page":"e298","DOI":"10.1371\/journal.pmed.0020298","volume":"2","author":"B Auvert","year":"2005","unstructured":"Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2(11):e298.","journal-title":"PLoS Med"},{"issue":"9562","key":"636_CR2","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1016\/S0140-6736(07)60312-2","volume":"369","author":"RC Bailey","year":"2007","unstructured":"Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet (London, England). 2007;369(9562):643\u201356.","journal-title":"Lancet (London, England)"},{"issue":"9562","key":"636_CR3","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/S0140-6736(07)60313-4","volume":"369","author":"RH Gray","year":"2007","unstructured":"Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet (London, England). 2007;369(9562):657\u201366.","journal-title":"Lancet (London, England)"},{"key":"636_CR4","unstructured":"Joint United Nations Programme on HIV\/AIDS, global AIDS strategy 2021\u20132026 \u2013 end inequalities. End AIDS. 2021 March. [cited 21 Jan 2022]. Available from: https:\/\/www.unaids.org\/en\/Global-AIDS-Strategy-2021-2026"},{"key":"#cr-split#-636_CR5.1","unstructured":"Joint United Nations Programme on HIV\/AIDS, World Health Organization. Voluntary medical male circumcision - steady progress in the scaleup of VMMC as an HIV prevention intervention in 15 eastern and southern African countries before the SARS-CoV2 pandemic, 2021 Feb 28 [Internet]"},{"key":"#cr-split#-636_CR5.2","unstructured":"[cited 2021 Nov 5]. 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(1999) Adverse event trends within a large-scale, routine, voluntary medical male circumcision program in Zimbabwe, 2014\u20132019. J Acquired Immune Deficiency Syndromes. 2021;88(2):173\u201380. This study reported low VMMC-associate adverse event rates from a large volume program attributed to various programmatic quality assurance and quality improvement activities.","journal-title":"J Acquired Immune Deficiency Syndromes"},{"issue":"7","key":"636_CR9","doi-asserted-by":"publisher","first-page":"e25369","DOI":"10.1002\/jia2.25369","volume":"22","author":"A Hellar","year":"2019","unstructured":"Hellar A, Plotkin M, Lija G, Mwanamsangu A, Mkungume S, Christensen A, et al. Adverse events in a large-scale VMMC programme in Tanzania: findings from a case series analysis. J Int AIDS Soc. 2019;22(7):e25369.","journal-title":"J Int AIDS Soc"},{"issue":"6","key":"636_CR10","doi-asserted-by":"publisher","first-page":"e0218137","DOI":"10.1371\/journal.pone.0218137","volume":"14","author":"P Marongwe","year":"2019","unstructured":"Marongwe P, Gonouya P, Madoda T, Murenje V, Tshimanga M, Balachandra S, et al. Trust but verify: is there a role for active surveillance in monitoring adverse events in Zimbabwe\u2019s large-scale male circumcision program? PLoS ONE. 2019;14(6):e0218137. This study demonstrated that active surveillance can identify a higher rate of VMMC-associated adverse events than passive reporting.","journal-title":"PLoS ONE"},{"issue":"8","key":"636_CR11","doi-asserted-by":"publisher","first-page":"e0253960","DOI":"10.1371\/journal.pone.0253960","volume":"16","author":"E Muchiri","year":"2021","unstructured":"Muchiri E, Charalambous S, Ginindza S, Maraisane M, Maringa T, Vranken P, et al. Description of adverse events among adult men following voluntary medical male circumcision: findings from a circumcision programme in two provinces of South Africa. PLoS ONE. 2021;16(8):e0253960.","journal-title":"PLoS ONE"},{"issue":"1","key":"636_CR12","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1186\/s12913-019-4604-1","volume":"19","author":"A Brito","year":"2019","unstructured":"Brito A, Korn A, Monteiro L, Mudender F, Maiela A, Come J, et al. Need for improved detection of voluntary medical male circumcision adverse events in Mozambique: a mixed-methods assessment. BMC Health Serv Res. 2019;19(1):855. This study suggests underreporting of VMMC-associated adverse events and demonstrated improved ascertainment of VMMC-associated adverse events when additional assessment methods are employed above passive reporting.","journal-title":"BMC Health Serv Res"},{"issue":"9","key":"636_CR13","doi-asserted-by":"publisher","first-page":"e0256955","DOI":"10.1371\/journal.pone.0256955","volume":"16","author":"I Mutanekelwa","year":"2021","unstructured":"Mutanekelwa I, Siziya S, Daka V, Kabelenga E, Mfune RL, Chileshe M, et al. Prevalence and correlates of voluntary medical male circumcision adverse events among adult males in the Copperbelt Province of Zambia: a cross-sectional study. PLoS ONE. 2021;16(9):e0256955.","journal-title":"PLoS ONE"},{"issue":"11","key":"636_CR14","doi-asserted-by":"publisher","first-page":"e0185904","DOI":"10.1371\/journal.pone.0185904","volume":"12","author":"KE Wirth","year":"2017","unstructured":"Wirth KE, Semo BW, Spees LP, Ntsuape C, Barnhart S, Ledikwe JH. A prospective cohort study of safety and patient satisfaction of voluntary medical male circumcision in Botswana. PLoS ONE. 2017;12(11):e0185904.","journal-title":"PLoS ONE"},{"issue":"10","key":"636_CR15","doi-asserted-by":"publisher","first-page":"e0258611","DOI":"10.1371\/journal.pone.0258611","volume":"16","author":"G O'Bryan","year":"2021","unstructured":"O\u2019Bryan G, Feldacker C, Ensminger A, Nghatanga M, Brandt L, Shepard M, et al. Adverse event profile and associated factors following surgical voluntary medical male circumcision in two regions of Namibia, 2015\u20132018. PLoS ONE. 2021;16(10):e0258611. This study identified that almost 40% of VMMC-associated adverse events, primarily infections, occurred after the second scheduled postoperative visit suggesting need for improvements to client wound care education and followup practices.","journal-title":"PLoS ONE"},{"key":"636_CR16","unstructured":"Population Services International, College of Surgeons of East, Central and Southern Africa, U.S. Centers for Disease Control and Prevention. Adverse event action guide for voluntary medical male circumcision by surgery or device 2nd Edition [Internet]. 2020 [cited 2021 Nov 5]. Available from: https:\/\/www.malecircumcision.org\/resource\/adverse-event-action-guide-vmmc-surgery-or-device-2nd-edition-updated-december-2020-new"},{"issue":"2","key":"636_CR17","first-page":"36","volume":"65","author":"J Grund","year":"2016","unstructured":"Grund J, Toledo C, Davis S, et al. Notes from the field: tetanus cases after voluntary medical male circumcision for HIV prevention \u2013 Eastern and Southern Africa, 2012\u20132015. MMWR. 2016;65(2):36\u20137.","journal-title":"MMWR"},{"issue":"8","key":"636_CR18","doi-asserted-by":"publisher","first-page":"613","DOI":"10.2471\/BLT.15.166777","volume":"94","author":"S Dalal","year":"2016","unstructured":"Dalal S, Samuelson J, Reed J, Yakubu A, Ncube B, Baggaley R. Tetanus disease and deaths in men reveal need for vaccination. Bull World Health Organ. 2016;94(8):613\u201321.","journal-title":"Bull World Health Organ"},{"key":"636_CR19","unstructured":"World Health Organization. Tetanus and voluntary medical male circumcision: risk according to circumcision method and risk mitigation. Report of the WHO technical advisory group on innovations in male circumcision\u2013consultative review of additional information, 12 August 2016 [Internet]. Geneva: WHO; 2016 Aug. 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Available at URL: https:\/\/www.state.gov\/wp-content\/uploads\/2020\/12\/PEPFAR-COP21-Guidance-Final.pdf"},{"key":"636_CR25","unstructured":"World Health Organization. Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics - guidelines [Internet]. Geneva: WHO; 2020 [cited 2021 Nov 22]. Available from: https:\/\/www.who.int\/publications\/i\/item\/978-92-4-000854-0"}],"container-title":["Current HIV\/AIDS Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11904-022-00636-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11904-022-00636-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11904-022-00636-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,17]],"date-time":"2022-12-17T12:53:01Z","timestamp":1671281581000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11904-022-00636-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,8]]},"references-count":26,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["636"],"URL":"https:\/\/doi.org\/10.1007\/s11904-022-00636-8","relation":{},"ISSN":["1548-3568","1548-3576"],"issn-type":[{"value":"1548-3568","type":"print"},{"value":"1548-3576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11,8]]},"assertion":[{"value":"19 August 2022","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 November 2022","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"This article does not contain any studies with human or animal subjects performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and Animal Rights and Informed Consent"}},{"value":"This publication has been supported by the President\u2019s Emergency Plan for AIDS Relief (PEPFAR). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}