Piloting PrePex for Adult and Adolescent Male Circumcision in South Africa--Pain Is an Issue

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Sep 26

PMID 26405786

Citations 14

Authors

Limakatso Lebina

Noah Taruberekera

Minja Milovanovic

Karin Hatzold

Miriam Mhazo

Cynthia Nhlapo

Nkeko Tshabangu

Mmatsie Manentsa

Victoria Kazangarare

Millicent Makola

Scott Billy

Neil Martinson

Affiliations

Soon will be listed here.

Abstract

Background: The World Health Organisation and the Joint United Nations Programme on HIV/AIDS have recommended the scale-up of Medical Male Circumcision (MMC) in countries with high HIV and low MMC prevalence. PrePex device circumcision is proposed as an alternate method for scaling up MMC.

Objective: Evaluate safety and feasibility of PrePex in South Africa.

Design: A multisite prospective cohort PrePex study in adults and adolescents at three MMC clinics. Participants were followed-up 8 times, up to 56 days after PrePex placement.

Results: In total, 398 PrePex circumcisions were performed (315 adults and 83 adolescents) their median ages were 26 (IQR: 22-30) and 16 years (IQR: 15-17), respectively. The median time for device placement across both groups was 6 minutes (IQR: 5-9) with the leading PrePex sizes being B (30%) and C (35%) for adults (18-45 years), and A (31%) and B (38%) for adolescents (14-17 years). Additional sizes (size 12-20) were rarely used, even in the younger age group. Pain of device application was minimal but that of removal was severe. However, described pain abated rapidly and almost no pain was reported 1 hour after removal. The Adverse Events rate were experienced by 2.7% (11/398) of all participants, three of which were serious (2 displacements and 1 self-removal requiring prompt surgery). None of the Adverse Events required hospitalization. The majority of participants returned to work within a day of device placement.

Conclusion: Our study shows that PrePex is a safe MMC method, for males 14 years and above. PrePex circumcision had a similar adverse event rate to that reported for surgical MMC, but device removal caused high levels of pain, which subsided rapidly.

Citing Articles

Implementing quality management strategies improves clinical quality as a voluntary medical male circumcision program in Namibia matures: a process analysis.

OBryan G, Ensminger A, Billah I, Sithole E, Nghatanga M, Brandt L BMC Health Serv Res. 2023; 23(1):1044.

PMID: 37773121 PMC: 10543846. DOI: 10.1186/s12913-023-10016-6.

Adverse event profile and associated factors following surgical voluntary medical male circumcision in two regions of Namibia, 2015-2018.

OBryan G, Feldacker C, Ensminger A, Nghatanga M, Brandt L, Shepard M PLoS One. 2021; 16(10):e0258611.

PMID: 34669709 PMC: 8528325. DOI: 10.1371/journal.pone.0258611.

Usability and acceptability of a two-way texting intervention for post-operative follow-up for voluntary medical male circumcision in Zimbabwe.

Feldacker C, Holeman I, Murenje V, Xaba S, Korir M, Wambua B PLoS One. 2020; 15(6):e0233234.

PMID: 32544161 PMC: 7297350. DOI: 10.1371/journal.pone.0233234.

Reducing provider workload while preserving patient safety via a two-way texting intervention in Zimbabwe's voluntary medical male circumcision program: study protocol for an un-blinded, prospective, non-inferiority, randomized controlled trial.

Feldacker C, Murenje V, Barnhart S, Xaba S, Makunike-Chikwinya B, Holeman I Trials. 2019; 20(1):451.

PMID: 31337414 PMC: 6651991. DOI: 10.1186/s13063-019-3470-9.

Is the PrePex device an alternative for surgical male circumcision in adolescents ages 13-17 years? Findings from routine service delivery during active surveillance in Zimbabwe.

Mavhu W, Hatzold K, Madidi N, Maponga B, Dhlamini R, Munjoma M PLoS One. 2019; 14(3):e0213399.

PMID: 30856228 PMC: 6411138. DOI: 10.1371/journal.pone.0213399.

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