Rwanda Focus (Kigali)

Rwanda: Plan to Circumcise Two Million Using New Devise Complete

The government plans to circumcise two million men in the next two years in an ambitious mass program that aims to reduce HIV transmission rate by 50 percent.

This follows successful trials of a non-surgical method of male circumcision called Prepex which experts say is easy to use and appropriate for the rural settings. Male circumcision has traditionally been performed surgically.

Prepex device is a simple non-surgical method that requires no sterile setting, no injected anesthesia, and it's a bloodless procedure with no need for sutures.

PrePex has an elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed a week after the placement of the device.

"The Ministry of Health has carried out clinical trials to evaluate this new device for one and a half years," said Dr Vincent Mutabazi, the lead investigator in the PrePex clinical trials in Rwanda. "After three major clinical trials required by the World Health Organization technical advisory group that reviews innovations on male circumcision devices, we see strong and compelling evidence on the safety, superiority over surgical circumcision and simplicity in the hand of lower cadre health practitioners like nurses."

During the trials, PrePex circumcision device was found to be five times faster than surgical because it is bloodless, requires no anesthesia, no sutures and no sterile settings as compared to the surgical procedure.

The procedure is simpler to use as it only requires ample dexterity in the hands of the user, said Mutabazi.

"During this clinical trial the PrePex male circumcision device show considerable less adverse effects in comparison to the surgical method," Mutabazi added.

In March 2007 during a meeting in Montreux, WHO/UNAIDS recommended that male circumcision be promoted as part of a comprehensive HIV prevention package. It was also agreed that countries with generalized heterosexual epidemics and low male circumcision rates be a focus for scaling up this intervention studies in Africa showed that male circumcision can reduce the risk of contracting HIV by 53%-60%.

There are some challenges in reaching all the people that need to be circumcised, especially in sub-Saharan Africa, as Mutabazi pointed out. "There are no sufficient health facilities and qualified personnel to handle mass circumcision programs. The PrePex device has the potential to facilitate rapid male circumcision scale-up programs for HIV prevention, an imminent need in Sub Saharan Africa."

The minister of health, Dr Agnes Binagwaho said that WHO is expected to approve the use of PrePex system after a review of clinical data that has been provided. "There is no need for a sterile environment to proceed with it and even nurses can use it," she said. It only takes 3 days to train people how to use the device whereas only highly trained and skilled medical personnel can perform surgical circumcision.

The PrePex male circumcision device is also being tested in Zimbabwe. "We have submitted the reports on our studies to the WHO technical advisory group and expect a response in one month time," added Mutabazi.

Dr Leon Ngeruka, who practices at the Kanombe Military Hospital praised the new system:

"Although it is still in its testing phase, most people preferred it to the surgical circumcision and if it is approved it may be the first choice for everyone."

The targeted group for the nationwide voluntary medical male circumcision program is men between 15 and 49 years old.

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