The acceptability and safety of the shang ring for adolescent male circumcision in Rakai, Uganda
Background: Medical male
circumcision (MMC) is recommended for HIV prevention in men. We assessed the
acceptability and safety of the Shang Ring device compared to the dorsal slit
method of MMC among adolescents.
Methods: HIV-negative,
uncircumcised adolescents aged 13 to 17 years who requested free MMC services
in rural Rakai, Uganda were informed about
the Shang Ring and dorsal slit procedures and offered a free choice of
procedure. Participants were followed at 7 days postoperatively to assess
adverse events (AEs) related to surgery and to remove the Shang Ring. Wound
healing was assessed at 4 weeks postoperatively.
Results: 464 adolescents
were enrolled, of whom 384 (82.8%) chose the Shang Ring and 80 the dorsal slit.
The Shang Ring was provided to 337 adolescents, because in 47 cases (12.1%)
appropriate ring sizes were unavailable, and in 3 cases Ring placement failed (0.9%).
334 adolescents received the Shang Ring and postoperative surgery-related
moderate AEs were 1.3%, compared to none among 130 dorsal slit recipients.
Complete wound healing at 4 weeks was 92.0% with the Shang Ring and 99.2% with
dorsal slit (p< 003). No adolescent resumed sex before 5 weeks. The mean time
for surgery was 5.2 minutes with the Ring and 12.3 minutes with the dorsal
slit. Mean time for Ring removal was 3.4 minutes.
Conclusions: The Shang Ring is
highly acceptable and safe among adolescents in this setting, and could improve
the efficiency of MMC services. However, back up surgical services are needed
in cases of Ring placement failures or unavailability of appropriate ring
sizes.
G. Kigozi1, R. Musoke1, N. Kighoma1, J. Nkale1, D. Serwada2, N. Sewankambo3, S. Watya1, F. Nalugoda1, G. Nalwoga1, D. Namuguzi3, D. Nkakalukanyi1, M. Anyokorit1, G. Nakigozi1, J. Mwinike1, M. Wawer4, R. Gray4
1Rakai Health Sciences Program, Kalisizo, Uganda, 2Makarerere University College of Health Sciences, School of Public Health, Kampala, Uganda, 3Makerere College of Health Sciences, Kampala, Uganda, 4Johns Hopkins Blomberg School of Public Health, Baltimore, United States