J Acquir Immune Defic Syndr. 2012 Feb 16. [Epub ahead of print]
Randomized Trial of the Shang Ring for Adult Male Circumcision with Removal at One to Three Weeks: Delayed Removal Leads to Detachment.
Barone MA, Awori QD, Li PS, Simba RO, Weaver MA, Okech JO, Aduda AO, Cherutich P, Muraguri N, Wekesa JM, Nyanchoka J, Perchal P, Masson P, Lee R, Goldstein M, Kioko J, Lusi O, Sokal DC.
1EngenderHealth, New York USA 2EngenderHealth, Nairobi, Kenya 3Center for Male Reproductive Medicine and Microsurgery, Department of Urology, Weill Cornell Medical College, New York, USA 4Homa Bay District Hospital, Homa Bay, Kenya 5FHI360, Durham, NC 6National AIDS/STD Control Programme, Nairobi, Kenya 7Ministry of Medical Services, Nairobi, Kenya 8The Population Council, New York, USA 9Ministry of Public Health and Sanitation, Nairobi, Kenya.
To assess healing with Shang Ring removal at different prespecified times; whether spontaneous detachment occurs with delayed removal; problems, complaints and acceptability of wearing the device; satisfaction among participants; and acceptability of the procedure among providers.
Fifty HIV-negative men underwent a Shang Ring circumcision in Kenya. Men were randomly assigned for device removal at 7 (15 men), 14 (15 men) or 21 days (20 men). Follow-up visits were at 7, 14, 21, 28 and 42 days after circumcision, and 2 days after removal.
Circumcision and device removal were conducted without significant problems. Mean times for circumcision and device removal were 6.5 (SD±2.4) and 2.5 (SD±0.8) minutes, respectively. Complete detachment of the device occurred in 22 (66.7%) men who wore it more than 7 days. Seven men (14.0%) with partial detachments requested removal 8-14 days post-circumcision due to pain/discomfort. Healing progressed normally in all participants; cumulative probabilities of complete healing were similar across groups. No severe or serious adverse events occurred. Acceptability among participants was high. Providers reported that Shang Ring circumcision was 'very easy' compared to the forceps-guided procedure.
The Shang Ring is safe and easy to use according to label instructions (7 day removal). Detachments occurred without significant problems, although some men requested removal of partially detached rings. Removal time had little effect on healing. These data help allay concerns about men not returning for ring removal and expand the evidence base suggesting the Shang Ring could facilitate rapid male circumcision roll-out in sub-Saharan Africa.
- [PubMed - as supplied by publisher]