title: The acceptability and safety of the Shang Ring for adult male circumcision in Rakai, Uganda.
abstract: OBJECTIVE
  Medical male circumcision (MMC) is recommended for HIV prevention in men. We assessed the acceptability and safety of the Shang Ring device compared with those of the dorsal slit method.
  
  
  METHODS
  HIV-negative, uncircumcised men aged 18 years or older who requested free MMC services in rural Rakai, Uganda, were informed about the Shang Ring and dorsal slit procedures and offered a free choice of procedure. Men were followed at 7 days postoperatively to assess adverse events related to surgery and to remove the Shang Ring. Wound healing was assessed at 4 weeks postoperatively.
  
  
  RESULTS
  Six hundred twenty-one men were enrolled, of whom 508 (81.8%) chose the Shang Ring and 113 the dorsal slit. The Shang Ring was provided to 504 men, among whom there were 4 failures of Ring placement (0.8%) that required surgical hemostasis and wound closure. Five hundred men received the Shang Ring and postoperative surgery-related moderate adverse events were 1.0%, compared with 0.8% among dorsal slit recipients. Complete wound healing at 4 weeks was 84% with the Ring and 100% with the dorsal slit (P < 0001). Resumption of intercourse before 4 weeks was 7.0% with the Ring and 15.0% with the dorsal slit (P = 0.01.) The mean time for surgery was 6.1 minutes with the Ring and 17.7 minutes with the dorsal slit. The mean time for Ring removal was 2.2 minutes.
  
  
  CONCLUSIONS
  The Shang Ring is highly acceptable and safe in this setting, and could improve the efficiency of MMC services. However, back-up surgical services are needed in cases of Ring placement failures.
authors.affiliation: *Rakai Health Sciences Program, Entebbe, Uganda; †Department of Urology, Mulago Hospital, Kampala, Uganda; ‡School of Public Health, Makerere University, Kampala, Uganda; §Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY; ‖Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; and ¶College of Health Sciences, Makerere University, Kampala, Uganda.
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Richard
authors.initials: R
authors.lastname: Musoke
authors.forename: Stephen
authors.initials: S
authors.lastname: Watya
authors.forename: Nehemiah
authors.initials: N
authors.lastname: Kighoma
authors.forename: Paschal
authors.initials: P
authors.lastname: Ssebbowa
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Frederick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Philip
authors.initials: P
authors.lastname: Li
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
authors.forename: Maria
authors.initials: M
authors.lastname: Wawer
authors.forename: Nelson
authors.initials: N
authors.lastname: Sewankambo
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D014454:Uganda; D014945:Wound Healing; D055815:Young Adult