USAID-funded Strengthening High Impact Interventions for an AIDS-free Generation (AIDSFree) Project, works to scale-up Voluntary Medical Male Circumcision (VMMC) in high HIV prevalence countries. This evaluation examined VMMC-associated adverse events (AEs), AE documentation, reporting and management practices, and mechanisms for identifying, reporting, and preventing AEs in three AIDSFree countries: Malawi, Namibia, and Tanzania. In Namibia and Tanzania, data on VMMC AEs were abstracted from medical records in clinics supported by AIDSFree. In all three countries key informant interviews were conducted and project documents were reviewed. In Namibia, medical records were found to be largely complete, but in Tanzania that data quality and chart completeness varied considerably. There was underreporting of moderate and severe AEs in both countries. Interview respondents in Malawi, Namibia, and Tanzania understood AE reporting and documentation mechanisms, but respondents in all three countries voiced concern that reporting of AEs might exclude them from future VMMC work. Prevention strategies focused on postoperative AEs, as patients often have limited understanding of wound care and hygiene, despite extensive counseling. Risk factor analysis was limited to Namibia over concerns of data quality in Tanzania. In Namibia, postoperative AEs were twice as likely as intraoperative AEs and the highest postoperative AE rate was observed among 15- to 24-year-olds.
- Training of clinic staff should emphasize appropriate documentation and charting of AEs, along with VMMC clinical skills and AE management.
- VMMC implementing partners should conduct routine data quality assessment with data validation to improve documentation.
- Increased emphasis should be placed on postoperative wound management, care, and hygiene.