HIV Prevention
Male Circumcision scale-up with new technology
Started by Agnès Binagwaho, MD, M(Ped) on 18 Feb 2011
Last edited by Sophie Beauvais on 01 Mar 2011
Dear All,
The Government of Rwanda has decided to scale-up its voluntary male circumcision program using the PrePex™ system, a new device for rapid adult male circumcision deployment in resource-limited settings (http://www.moh.gov.rw/index.php?option=com_content&view=article&id=181:rwanda...). The PrePex system works through a special elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed after a week. The procedure is quick, simple, bloodless and safe.
In 2010, a nationally sponsored study to test the safety and efficacy of the system was initiated: http://clinicaltrials.gov/ct2/show/NCT01150370. Results showed its potential to revolutionize male circumcision as an HIV prevention method. And a new study is currently under way in Rwanda to compare it to surgical circumcision for rapid scale-up of male circumcision in resource limited setting:http://clinicaltrials.gov/ct2/show/NCT01284088.
This roll-out is part of a national comprehensive plan for HIV prevention that you can download in PDF here: http://www.moh.gov.rw/index.php?option=com_docman&task=cat_view&gid=67&Itemid=14
We hope to decrease the HIV incidence rate by 50% by circumcising two million adults in two years.
Please share your thoughts/experience. Thank you.
Keywords: adult bloodless circumcision Developing targeted interventions no anesthesia no sterile settings no sutures Scaling up & managing at scale

Alliance Nikuze
Dear Dr Agnes,
I am an HIV prevention research advocate and i have worked with different civil society organizations in Rwanda in order to engage them in the roll-out of MC.
One of the demands from community members was to avail an easier tool for MC surgery, something less painful which will not be an obstacle in terms of intimacy and that won't stop you from performing your other daily activities.
So, this prepex system holds lot of promises and great opportunities for rapid scale-up of MC, one of them being to circumcise hundreds of men per day. I would like to have your thoughts on how these numbers could affect the MC counseling as a critical component of MC programs?
Best,
Alliance
7:34 AM, 8 Jun 2011 | Permalink
Sarah Arnquist
For an interesting discussion on methods used for infant male circumcision,
see this discussion going on in the surgery community.
Techniques for circumcision in boys
http://www.ghdonline.org/surgery/discussion/techniques-for-circumcision-in-boys/
9:42 AM, 8 Jun 2011 | Permalink
John Nicholson
Thank you for posting the information on Rwanda's scale-up of male circumcision. It will be interesting to follow this and see the results. You might be interested in an upcoming film event on June 22, which covers the scale-up in Kenya and Swaziland. The film also comes with resources on scale-up that may address your question about counseling.
For more info: http://j.mp/jNlTtE
8:40 AM, 9 Jun 2011 | Permalink