Abstract
For prevention of HIV, early infant male circumcision (EIMC) needs to be scaled up in countries with high HIV prevalence. Routine EIMC will maintain the HIV prevention gains anticipated from current adult male circumcision initiatives. We present here the results of a field study of EIMC conducted in Zimbabwe. The study was observational and based on the World Health Organization (WHO) framework for clinical evaluation of male circumcision devices. We recruited parents of newborn male infants between August 2013 and July 2014 from 2 clinics. Nurse-midwives used the AccuCirc device to circumcise eligible infants. We followed participants for 14 days after EIMC. Outcome measures were EIMC safety, acceptability, and feasibility. We enrolled 500 male infants in the field study (uptake 11%). The infants were circumcised between 6 and 60 days postpartum. The procedure took a median of 17 minutes (interquartile range of 5 to 18 minutes). Mothers' knowledge of male circumcision was extensive. Of the 498 mothers who completed the study questionnaire, 91% knew that male circumcision decreases the risk of HIV acquisition, and 83% correctly stated that this prevention is partial. Asked about their community's perception of EIMC, 40% felt that EIMC will likely be viewed positively in their community; 13% said negatively; and 47% said the perception could be both ways. We observed 7 moderate or severe adverse events (1.4%; 95% confidence interval, 0.4% to 2.4%). All resolved without lasting effects. Nearly all mothers (99%) reported great satisfaction with the outcome, would recommend EIMC to other parents, and would circumcise their next sons. This first field study in sub-Saharan Africa of the AccuCirc device for EIMC demonstrated that EIMC conducted by nurse-midwives with this device is safe, feasible, and acceptable to parents.
Highlights
Global Health: Science and Practice 2016 | Volume 4 | Supplement 1(VMMC).[1,2,3] early infant male circumcision (EIMC) is likely to prevent HIV acquisition more effectively than VMMC; EIMC is carried out long before an individual becomes sexually active and avoids the risk associated with sex during the healing period.[4]
Of the 498 mothers who completed the study questionnaire, 91% knew that male circumcision decreases the risk of HIV acquisition, and 83% correctly stated that this prevention is partial
EIMC is likely to prevent HIV acquisition more effectively than VMMC; EIMC is carried out long before an individual becomes sexually active and avoids the risk associated with sex during the healing period.[4]
Summary
Global Health: Science and Practice 2016 | Volume 4 | Supplement 1(VMMC).[1,2,3] EIMC is likely to prevent HIV acquisition more effectively than VMMC; EIMC is carried out long before an individual becomes sexually active and avoids the risk associated with sex during the healing period.[4]. A number of circumcision devices are used with infants, including the Mogen clamp, Gomco clamp, and S42. Circumcision using the Mogen clamp can result in partial or total amputation of the glans penis or removal of too little foreskin (in which case the remaining foreskin remains vulnerable to infection with HIV).[5,6,7,8] A mismatch in sizes of the separate pieces of the Gomco clamp can result in laceration of the glans penis.[5,9] Proximal migration of the Plastibell during circumcision can result in necrosis of the glans and other injuries; this risk is increased if the incorrect size of ‘‘bell’’ is used.[5,10,11,12]. For prevention of HIV, early infant male circumcision (EIMC) needs to be scaled up in countries with high. Routine EIMC will maintain the HIV prevention gains anticipated from current adult male circumcision initiatives. We present here the results of a field study of EIMC conducted in Zimbabwe
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