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New male circumcision method cheaper, quicker

The Independent Reporter

The World Health Organisation recommends it as part of a comprehensive HIV prevention package

When Edmund Musonera, 25, was approached by health officials from Bugesera district to persuade him to undergo circumcision using a new device, the PrePex system, he was afraid.

Would it not be too painful? Besides, Musonera, a motor cyclist worried that undergoing circumcision would affect his work and starve his family for months. He was wrong on both counts.

He only needed a few days to heal and this was done without going through surgical operation.

“I did not believe that I could take few days to heal and go back into business. It was bloodless which makes it less worrying,” he told The Independent in an interview.

Alex Bugingo has similar fears. Nine months ago, he was persuaded to try the PrePex method by his colleague Wilber Kanimba, a student at the National University of Rwanda.

“Kanimba had gone through the same experience and told us it was not so painful. I got courage and tried it and within a few days, it was healed. People who went for surgical circumcision say it is very painful especially to adults,” says Bugingo, a businessman in Nyagatare.

Officials from the Ministry of Health say the government plans to expand its national voluntary male circumcision programme using PrePex which, the ministry says, saves time and money.

Dr Vincent Mutabazi, the Director of Research Grants Unit and Lead Investigator in the Prepex trials at the Rwanda Biomedical Centre, says a study by the health ministry found the device to be safe and effective.

An additional research that targets men that could not in the past be circumcised using the device due to their foreskin anatomy is about to be concluded in Rwanda Military Hospital.

Dr Mutabazi says by combining the device with local injected anaesthesia and minor incision to the foreskin, health officials can now treat these men as well.

“The research is still ongoing but so far, no safety issues with this new method. A big number is turning up for this,” Mutabazi said.

The PrePex device works through a special elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed after a few days.

“Results of the study so far have shown that the device procedure time of 3.1 minutes (skin to skin), was significantly shorter than the surgical procedure time (15.4 minutes skin to skin),” Mutabazi says.

He said most of the case studies involved men from Kigali and Bugesera areas while campaigns outside of the clinical evaluation took place in Cyangugu, Gicumbi, Butare and Iwawa.

In 2010, a randomised controlled study by officials from Ministry of Health, comparing the safety and efficacy of the PrePex to a surgical circumcision method took place in Bugesera.

The study, according to officials from the Ministry of Health showed that men embraced PrePex more than the surgical one.

The study was audited by World Health Organization team the following year and it was approved three years ago by the UN body’s Male Circumcision Technical Advisory Group.

The ongoing research comes after the Ministry of Health also announced early this year the successful trials of Pre PEX at Nyamata and Kanombe Military hospitals.

Rwanda is the first African country to study and start scale up preparations with PrePex device. Other countries which are trying the PrePex system after Rwanda’s experience include Botswana, Zimbabwe, Mozambique, Uganda, Kenya and now Zambia.

A report from the phased implementation research was concluded in February this year and, according to Mutabazi it was sent to the country’s major donors.

“We are happy to report that we recently received funds from Global Fund, enabling the Ministry of Health to start PrePex national scale up program,’ he revealed.

Although cost-effectiveness studies are still under way, ministry officials say the elimination of factors such as anaesthetic and highly trained staff as well as the gains made by the shorter healing time meant it was likely that the PrePex system would be cheaper than traditional clinical male circumcision.

Rwanda›s HIV prevention strategy includes a plan to circumcise an estimated two million adult men within two years. So far, only 15 percent of Rwandan men are circumcised, according to the government.

The World Health Organisation (WHO) and UNAIDS have recommended the inclusion of voluntary medical male circumcision in HIV prevention programmes, alongside counselling and testing.

Officials from Health Ministry say there is a high demand for male circumcision, especially among young adults.

“To date, 1,160 circumcision procedures using the PrePex device have been conducted safely in Rwanda, where 888 procedures were performed in the framework of clinical studies,” Mutabazi said.

The objective is to reach 2 million adult men in a period of 24 months, to achieve the national goal of reducing HIV incidence rate by 50 percent.

The government has been keen to explore innovations in male circumcision that would be more suitable for non-physicians, in non-sterile rural settings, which would minimise the burden on the existing healthcare system.

The Prepex device is the first known to facilitate male circumcision without injectable anaesthesia, stitches or sterile settings.

A few years ago, WHO recommended that male circumcision be promoted as part of a comprehensive HIV prevention package after randomised and controlled studies in Africa showed male circumcision can reduce the lifetime risk of HIV infection by 53–60 percent.

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