Browsing by Author "Kighoma, Nehemiah"

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    Designing and Usage of a Low-cost Penile Model for Male Medical Circumcision Skills Training in Rakai, Uganda
    (Urology, 2011) Kigozi, Godfrey; Nkale, James; Wawer, Maria; Anyokorit, Margaret; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Kiwanuka, Noah; Mwinike, Joshua; Kighoma, Nehemiah; Nalwoga, Grace K.; Nakigozi, Gertrude F.; Katwalo, Henry; Serwadda, David; Gray, Ronald H.
    To describe the designing and usage of a locally made low-cost penile model used for male medical circumcision (MMC) skills training. The Rakai MMC training team has experienced a number of challenges during conduct of MMC skills training, one of which was the lack of a model to use for MMC skills training. To address this challenge, the Rakai MMC skills training team has designed and developed a low-cost penile model for use in MMC skills training. The model has been successfully used to demonstrate external penile anatomy, to describe the biological mechanisms through which male circumcision (MC) prevents HIV acquisition, and for demonstration and practice of the MMC procedures. With an initial cost of only $10 and a recurrent cost of $5, this is a cost-efficient and useful penile model that provides a simulation of normal penile anatomy for use in MC training in resource limited settings. It has also been used as a visual aid in preoperative education of patients before receiving male circumcision. The model can be improved and scaled up to develop cheaper commercial penile models.
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    Effects of Medical Male Circumcision (MC) on Plasma HIV Viral Load in HIV+ HAART Nai¨ve Men; Rakai, Uganda
    (PLoS ONE, 2014) Kigozi, Godfrey; Musoke, Richard; Kighoma, Nehemiah; Watya, Stephen; Serwadda, David; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Tobian, Aaron; Makumbi, Fredrick; Galiwango, Ronald Moses; Sewankambo, Nelson; Nkale, James; Kigozi Nalwoga, Grace; Anyokorit, Margaret; Lutalo, Tom; Henry Gray, Ronald; Wawer, Maria Joan
    Medical male circumcision (MC) of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda. 195 consenting HIV-positive, HAART naı¨ve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE).
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    Efficacy of Knowledge and Competence-Based Training of Non-Physicians in the Provision of Early Infant Male Circumcision using the Mogen Clamp in Rakai, Uganda
    (BJU international, 2017) Kankaka, Edward Nelson; Kigozi, Godfrey; Kayiwa, Daniel; Kighoma, Nehemiah; Makumbi, Frederick; Murungi, Teddy; Nabukalu, Dorean; Nampijja, Resty; Watya, Stephen; Namuguzi, Daniel; Nalugoda, Fred; Nakigozi, Gertrude; Serwadda, David; Wawer, Maria; Gray, Ronald H.
    To assess acquisition of knowledge and competence in performing Early Infant Male Circumcision (EIMC) by non-physicians trained using a structured curriculum.Training in provision of EIMC using the Mogen clamp was conducted for 10 Clinical Officers (COs) and 10 Registered Nurse Midwives (RNMWs), in Rakai, Uganda. Healthy infants whose mothers consented to study participation were assigned to the trainees, each of whom performed at least 10 EIMCs. Ongoing assessment and feedback for competency were done, and safety assessed by adverse events.Despite similar baseline knowledge, COs acquired more didactic knowledge than RNMWs (P = 0.043). In all, 100 EIMCs were assessed for gain in competency. The greatest improvement in competency was between the first and third procedures, and all trainees achieved 80% competency and retention of skills by the seventh procedure. The median (interquartile range) time to complete a procedure was 14.5 (10-47) min for the COs, and 15 (10-50) min for the RNMWs (P = 0.180). The procedure times declined by 2.2 min for each subsequent EIMC (P = 0.005), and rates of improvement were similar for COs and RNMWs. Adverse events were comparable between providers (3.5%), of which 1% were of moderate severity.Competence-based training of non-physicians improved knowledge and competency in EIMC performed by COs and RNMWs in Uganda.
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    Use of a mixture of lignocaine and bupivacaine vs lignocaine alone for male circumcision under local anaesthesia in Rakai, Uganda
    (BJU international, 2012) Kigozi, Godfrey; Musoke, Richard; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemiah; Ssebanenya, William; Mwinike, Joshua; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Nalwoga, Grace; Nakigozi, Gertrude; Kiwanuka, Noah; Makumbi, Frederick; Lutalo, Tom; Serwadda, David; Wawer, Maria; Gray, Ronald
    Male circumcision (MC) has been shown to reduce the risk of HIV acquisition by 50 – 60% [ 1 – 3 ] and the WHO now recommends it as one of the proven methods for HIV prevention [ 4 ] . Several programmes in sub-Saharan Africa have initiated MC implementation. For MC to be effective at a community level there is need to achieve high MC coverage, and modelling suggests that the higher the prevalence of MC the greater the impact on HIV incidence [ 5 ] . One reason consistently cited by men for not accepting MC is fear of pain during surgery [ 6 – 10 ] . Our experience in Rakai is that when men are offered MC, only a few men initially come for surgery, and the majority, fearing pain, wait to hear the experiences of men who have had surgery.