Bophelo Pele Male Circumcision Process
Information session:
The process always start with an information session. Anyone can attend an Information session, parents of potential participant in the project, Spouses and partners of men who are considering to get circumcised, and all men who are considering to get circumcised.
The session always start by going through the already existing safe sex messaging, the ABC, Abstinence, Be faithful to one partner and condomise messages, as well as partner reduction, and sexual debut delay messages.
Finally there is a section on the actual intervention of male circumcision.
Individual counselling:
- If the individual decide to go through with the surgery after the information session, they will be met by a counsellor who will engage them in an individual counselling session.
- During the individual counselling session the counsellor will go though the messages that was received during the information session again, this time making it a lot more personal and making applying the strategies to the individuals risk profile. This is often the first time for many potential participants that they get to have a conversation one-on-one with someone about their risk profile and get the opportunity for the first time to discuss their behaviour with a counsellor in confidence.
- During the individual counselling the participant will decide whether to go through with the circumcision surgery.
- The participant is then offered VCT.
- The pre-test counselling will be done by the same counsellor as there is already rapport between the individual and the counsellor.
- If the participant tests HIV+, they will immediately be offered a CD4 Cell count test. If this measure is below 200, the participant will be referred to a treatment facility in order for them to be put on treatment. They may return later when their cell count has recovered adequately for circumcision.
- Testing is still voluntary and those who decide not to test will still be included.
- The last process in the individual counselling is to do the informed consent, and prepare the rest of the paper work required by the project. A photo is taken, and the participant gets the consent that he has signed, a copy of the information protocol, a pamphlet on the after care of the wound, and a card to be presented at the surgery.
- The participant now goes home and will return 3 days later for surgery. This waiting period is meant for the participant to consider everything that he has heard and have the time to discuss with family and friends.
Surgery
The surgical centre is a WITS Urology Department Study Site
- It was soon realised that a High Volume high quality model was needed to cope with the demand.
- Dr. Dino Rech and Dr. Sean Doyle then developed the current model for surgery.
- It is situated in a large room and have 7 bays separated by surgery curtains.
- In this configuration one doctor, 4 auxiliary nurses and 1 suture nurse, can perform 10 MC per hour
- The maximum capacity of the centre, including more private surgery rooms and 3 doctors in attendance is 150 per day.
- Complications during and after surgery remain low, at about 2%, and most of these are not serious complications.
- There is a follow-up visit 2-3 days after surgery
- There is an Emergency response for participants after surgery, with a 24 hour toll free number in case of problems, and vehicles that will fetch a participant if more action is needed.
