Mobilization Tools For Male Circumcision; Lessons from Kenya and Zambia

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Randomized Controlled Trial of the Shang Ring versus Conventional Surgical Techniques for Adult Male Circumcision: Safety and Acceptability

Sokal, David C. MD; Li, Philip S. MD; Zulu, Robert M.Med Surgery; Awori, Quentin D. MBChB; Combes, Stephanie L. MA; Simba, Raymond O. MBChB; Lee, Richard MD; Hart, Catherine AAS; Perchal, Paul MA; Hawry, Hayden J. MHS; Bowa, Kasonde FRCS; Goldstein, Marc MD; Barone, Mark A. DVM

Published Ahead-of-Print
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Abstract

Objective: To compare clinical profiles of Shang Ring vs. conventional circumcisions.
Design: Parallel group open-label randomized controlled trial with one-to-one allocations in two sites.
Methods: We enrolled HIV-negative men aged 18-54 in Homa Bay, Kenya, and Lusaka, Zambia and followed them at 2, 7, 14, 21, 28, 42 and 60 days after Shang Ring vs. conventional circumcision. We compared duration of surgery, post-operative pain using a visual analog scale, adverse events rates, time to complete wound healing by clinical assessment, participant acceptability, and provider preferences between circumcision groups.
Results: We randomized 200 men to each group; 197 and 201 contributed to the Shang Ring and conventional surgery analyses, respectively. Adverse event rates were similar between groups. Pain scores at most time points were similar, however the Shang Ring group reported higher scores for worst pain during erections (3.5+/-1.9 vs. 2.3+/-1.7; p<0.001). Significantly more men were satisfied with the cosmetic appearance following Shang Ring MC, 95.7% vs. 85.9% (p=0.02) in Kenya, and 96.8% vs. 71.3% (p<0.01) in Zambia. Although median time to complete wound healing was 43 days in both groups, conventional circumcisions healed on average 5.2 days sooner (p<0.001). Shang Ring procedures took one-third the time of conventional MC, 7 vs. 20 minutes. All circumcision providers preferred the Shang Ring.
Conclusion: Safety profiles of the two techniques were similar, all MC providers preferred the Shang Ring technique, and study participants preferred the Shang Ring's cosmetic results. The Shang Ring should be considered for adult MC as programs scale-up.
(C) 2013 by Lippincott Williams & Wilkins

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