CHAPS’ roots lie in research
CHAPS evolved in 2010 from the pioneer Orange Farm research programme that demonstrated the 60% protective benefit of medical male circumcision, which contributed to the WHO’s recommendations in 2007.
This has led to CHAPS’ recognition in researching and promoting the scale-up of voluntary medical male circumcision for HIV prevention in South Africa and abroad. With both programmatic and research expertise in voluntary medical male circumcision, CHAPS is well positioned to work closely with the South African Department of Health to implement and systematically monitor MMC programmes.
During the past year, CHAPS embarked on a number of interesting research studies, which are briefly described below.
PrePex Pilot Study
The Prepex device is an innovative piece of technology which is promoted as a “ non-surgical device. Studies from other settings have shown reduced pain levels. There is no need to cut live tissue and no need for local anesthesia.
For these reasons the National Department of Health (NDoH) and South African Government (SAG) is interested in using Prepex more widely specifically to access new geographies and hard to reach communities by having Clinical Associates and nurses trained in using this new device. In order to assess the safety and feasibility of the PrePex device a pilot study was undertaken to examine the perceptions and experience of providers using the PrePex device. In addition, the safety and acceptability as judged by both the participants as well as the providers were also examined.
The PrePexTM Pilot Study, evaluating the safety and acceptability of PrePexTM, was conducted from 4 April 2014 to 11 of June 2015. A sample of 802 HIV-negative men aged 18-49 were recruited and circumcised using PrePexTM. The study took place in 3 CHAPS facilities, i.e. Zola Clinic, Katlehong North Clinic and Orange Farm Clinic in Gauteng, South Africa. A full report has been submitted to funders ANOVA and USAID for review.
CircumQ Pilot Study
The CircumQ is a single-use multi-material instrument that does not remain on the penis beyond the surgical room. It is used as an aid in circumcisions- as an alternative to the forceps-guided/ dorsal slit. The CircumQ surgical aid functions as a template during the cutting phase and is then removed, in a manner similar, in principle, to a Gomco clamp. It completely removes the risk of cutting the glans of the penis during the circumcision procedure.
CircumQ was launched as a non-comparative study for building a clinical profile for a new VMMC surgical aid device.CHAPS recruited 50 HIV-negative males aged 18-49 at 2 CHAPS sites in Gauteng. The study ran from 10 March to 15 April 2015. A full report has been submitted to the funder (SAFIKA House). The second phase of the pre-qualification procedure- the randomised control trial, with a sample of 100 males aged 18-49 has commenced.
HIV Self-Testing Kit Study
The OraSure OraQuick FDA-approved HIV self-testing kit is an innovative method of home-based testing that allows clients to test themselves for HIV in the comforts of their own home, without the use of needles and blood. This oral test requires clients to swab their gums, and tests fluid called oral mucosal transudate, which lives in the cheeks and gums. Aside from the fluid it uses for testing, the oral HIV test works just like the HIV blood tests, that is, it tests for HIV antibodies and not the actual disease.
The World Health Organization recently released updated HIV prevention guidelines advocating self-testing. In an effort to increase HIV testing rates in South Africa, the HIV Self-testing Kit Study evaluated the feasibility of HIV self-testing kits. It was aimed particularly at individuals who have never tested before. The Population Services International (PSI) together with its local, South African affiliate, the Society for Family Health (SFH), partnered with CHAPS to evaluate whether HIV self-test kits are a viable, cost-effective solution to increasing HCT uptake in SA. The primary objective of this study was to identify facilitators of and barriers to acceptability and scale-up of the HIV self-testing kit. The sample consisted of 645 participants. The study was conducted in 2 clinics, namely AMCARE Clinic and Zuzimpilo Medical Centre. The study took place between May and September 2015. Follow-up calls and data capturing are underway.
Early Infant Male Circumcision (EIMC)
The set target of circumcising 4.3 million men in South Africa by 2015 is underway, with 1.3 million circumcisions performed between 2010 and 2013. In South Africa, modelling suggests that VMMC performed between birth and 20 years has the greatest effect on HIV incidence and is the most cost effective. The benefits of EIMC in terms of decreasing HIV are not realised until a male’s sexual debut. Including EIMC during the scale up phase would lead the need to circumcise fewer 10-14 year olds during the maintenance phase. This also means that by 2027, in order to maintain 80% coverage, South Africa would only need to provide EIMC. This would lead to a 3% increase in HIV infections averted, 29% increase in male circumcisions required and a cost saving of approximately 9%. Based on these findings, UNICEF has partnered with CHAPS to Implement an Early Infant Male Circumcision (EIMC) pilot study in South Africa.
The EIMC pilot study aimed at developing safe, cost-effective and sustainable service delivery models for EIMC in South Africa, began in March 2016. Two key objectives will be fulfilled by the end of the study – a service delivery model for EIMC implementation in South Africa, as well as policy briefs and programme documents, which include training and communication materials for EIMC.
The Research team represented CHAPS at 14th World Congress on Public Health in February 2015 in India, Kolkata. Two papers were accepted for oral presentations:
- Title: “It’s a good idea and then again it’s not”: The perceived advantages and disadvantages in scaling-up the HIV self-testing kit in Johannesburg, South Africa’. Presented by Saira Abdulla
Authors: Saira Abdulla, Alexandra Spyrelis, Sasha Frade, Tessa Meyer, Miriam Mhazo, Dirk Taljaard, Scott Billy
- Title: ‘Cultural and Traditional Factors Affecting the likelihood of parents’ uptake of early infant male circumcision (EIMC) in Soweto and Orange Farm, South Africa.
Presented by Genevieve N.Dean
Authors: Genevieve N.Dean, Sasha Frade, Alexandra Spyrelis, Saira Abdulla, Dino Rech, Dirk Taljaard.