Non-attendance of day seven follow up visit by circumcised persons and associated factors, at selected Rakai program sites, Uganda

Abstract

Introduction: A substantial number of male subjects are now receiving safe male circumcision(SMC) for HIV prevention. Attendance of day 7 follow up (FUP) visit is important to ascertain progress of wound healing and treat adverse events. Data on attendance of FUP schedules after circumcision are limited in Uganda. Thus, this study sought to determine the prevalence of nonattendance of day 7 FUP visit and associated factors, among circumcised persons at selected Rakai program sites, Uganda. Methods: This cross sectional analytical study with mixed methods, utilized data from 766 males aged ≥10 years, circumcised between November 1st, 2016 and December 31st, 2017 under the ‘Stylish man campaign’ to increase demand for circumcision services for men. We also conducted 24 in depth interviews (IDIs) among clients who missed day 7 FUP visit, and 6 key informant interviews with providers. Covariates included: age, marital status, occupation; education, tribe, religion, phone access, facility level, and time of circumcision. Modified Poisson regression model was used to estimate prevalence ratios PR and 95% confidence intervals of nonattendance of day 7 FUP visit. Themes emerging from IDIs were grouped according to Andersen healthcare utilization model, and analyzed manually, to explore reasons for nonattendance. Results: The prevalence of nonattendance of day 7 FUP visit was 32.0% (245/766). Factors associated with nonattendance included; unmarried status adjusted PR=1.59, 95% CI 1.04, 2.42; Non-Muganda ethnicity adj. PR=1.41, 95%CI 1.04, 191; lack of phone access adj. PR=1.44, 95% CI 1.13, 1.84 and above-center II facility level attached to after surgery i.e. level IIIs adj. PR= 4.97 95% CI 3.10, 7.99; level IV adj. PR=2.16 95% CI 1.25 3.75 and Hospitals adj. PR= 3.41 95% CI 1.98, 5.88. Evening circumcision procedures >2.00pm were protective adj. PR= 0.80 95% CI 0.66, 0.97. Reasons for nonattendance as adduced from qualitative interviews included: work commitments, long distances, lacking transport, unclear or no information, low risk perception of adverse event, and unavailability of service providers. Conclusion: The prevalence of nonattendance of day 7 FUP was lower than 80% previously reported for Uganda. Targeted interventions to reduce it further may include: ensuring clear uniform messages and that providers are available at the SMC site to attend to clients, serving closer to their community of residence than referring them to higher level facilities, strengthening active FUP and capturing extra phone contacts for relatives for clients without accessible phones as well as intensifying education and counseling sessions emphasizing benefits of FUP especially for working and low risk perceiving clients during SMC demand generation campaigns.