Shang Ring Versus Forceps-Guided Adult Male Circumcision

Kanyago, Samuel; Riding, David; Mutakooha, Elichum; O, Alcides Lopez de la; Siedner, Mark J.

doi:10.1097/qai.0b013e3182965d67

Cited by 17 publications

(17 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The primary limitations of the study were a) the relatively small number of clinics in the cluster sample, which might affect external validity, and b) offering only a surgical VMMC option (the uptake of VMMC remains limited by fear of pain, the surgical procedure and adverse events). Novel non-surgical or minimally-surgical techniques are currently being evaluated, e.g., PrePex, 20 Shang Ring, 21 which may increase acceptability 22 when offered as an alternative to surgery. 23…”

Section: Discussionmentioning

confidence: 99%

The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial

et al. 2015

View full text Add to dashboard Cite

BackgroundWidespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention designed to increase demand for VMMC among these “hard to reach” men.MethodsThis cluster randomized controlled trial was conducted from 2012 to 2014 in Lusaka, Zambia (HIV prevalence = 20·8%). 13 Community Health Centers (CHCs) were stratified by HIV voluntary counseling and testing (VCT) rates and patient census and randomly assigned (5:5:3) to Experimental, Control or Observation Only conditions. CHC health care providers at all 13 sites received VMMC training. Trial statisticians did not participate in randomization. 800 uncircumcised HIV-, post-VCT men, 400 per condition, were recruited; female partners were invited to participate. The primary outcome was the likelihood of VMMC by 12 months post-intervention. The trial registration is NCT 01688167.Findings161 participants in the Experimental condition underwent VMMC as compared to 96 Control participants [adjusted odds ratio = 2·45, 95% CI = (1·24, 4·90) p = ·0166]. Post-VMMC condom use among Experimental condition participants increased compared to baseline, with no change among Control participants. No adverse events related to study participation were reported.InterpretationThe Spear and Shield intervention combined with VMMC training was associated with a significant increase in the number of VMMCs performed as well as in condom use among “hard to reach” Zambian men. Results support the importance of comprehensive HIV prevention programs that increase supply of and demand for VMMC services.FundingNIH/NIMH R01MH095539.

show abstract

Section: Discussionmentioning

confidence: 99%

The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Future work must consider: (1) Objective ascertainment of circumcision status via genital examination; (2) Careful assessment of anal sex role/positioning; 45,46 (3) Detailed data on condom use and sexual risk taking; (4) Local acceptability of adult circumcision, whether favorable 35,47-50 or less so; 31,51 (5) Appropriate study design. 52-54 Before clinical trials are initiated, feasibility studies may be necessary for evaluating cultural contextual factors that may affect recruitment and external validity, surgery-alternative techniques, 55-59 decision analysis models of costs vs. benefits of circumcision among MSM, and community views of circumcision and willingness to engage circumcision efficacy trials. In a registered clinical trial (NCT01068015) where circumcision is one component of a package of integrated interventions, 50% of Chinese MSM participants stated willingness, but only 15% eventually accepted circumcision (personal communication, Dr. Jie Xu).…”

Section: Discussionmentioning

confidence: 99%

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China

Qian

Ruan

Liu³

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Background Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain. Methods Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed. Results Among1155 participants (242 known seropositives and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by exam) was associated with 47% lower odds of being HIV seropositive (adjusted odds ratio [aOR], 0.53; 95% confidence interval [CI], 0.27-1.02) after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR, 0.38, 95%CI, 0.09-1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR, 0.54, 95%CI, 0.25-1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR, 0.15; 95%CI, 0.04-0.65). Circumcision was not associated clearly with lower syphilis risk (aOR, 0.91; 95%CI, 0.51-1.61). Conclusions Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.

show abstract

“…In a bid to reduce the complications especially with the required volume of VMMC and shortage of surgical manpower, devices have been developed to reduce the intraoperative time, pain, hemorrhage and other complications noted with conventional circumcision as well as improve the cosmetic appearance of the phallus (28,40,52,53). These devices are either in situ devices (ISD) e.g., Shang Ring (Wu Hu SNNDA Medical Treatment Appliance Technology Co., LTD., Wu Hu, China) and PrePex (Circ Med Tech Limited) or circular disposable devices (CDD).…”

Section: Devices Used For Male Circumcision In Africamentioning

confidence: 99%

Circumcision and its effects in Africa

Lawal¹,

Olapade-Olaopa²

2017

Transl. Androl. Urol.

View full text Add to dashboard Cite

Male circumcision is one of the most commonly performed procedures in Africa, with a wide variation between the different regions on the practice. This is because circumcision is often done for religious and cultural or traditional reasons, which includes being part of rituals or rite of passage to adulthood. There had been few medical indications for the procedure until the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) pandemic, which is prevalent in many of the countries in the region. Evidence from randomized controlled trials conducted in the continent had shown that male circumcision could be instrumental to reducing the transmission of HIV/AIDS in heterosexual couples in high disease prevalent and low circumcision prevalent areas. This had led to the roll-out of large population-based adult male circumcisions as well as the development of tools to facilitate the procedure. Circumcision, however, is not without complications and the incidence appears related to the age of the patient, where the procedure was done, technique used and level of proficiency of the practitioners. This article reviews the practice of circumcision in Africa and highlights the impact of the procedure on the continent.

show abstract

Shang Ring Versus Forceps-Guided Adult Male Circumcision

Cited by 17 publications

References 12 publications

The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial

The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial

Lower HIV Risk Among Circumcised Men Who Have Sex With Men in China

Circumcision and its effects in Africa

Contact Info

Product

Resources

About