Adverse events profile of PrePex a non-surgical device for adult male circumcision in a Ugandan urban setting.
BACKGROUND
Safe Male Circumcision is a proven approach for partial HIV prevention. Several sub Saharan African countries have plans to reach a prevalence of 80% of their adult males circumcised by 2015. These targets require out of ordinary organization, demand creation, timely execution and perhaps the use of SMC devices.


OBJECTIVE
To profile Adverse Events rate and acceptance of PrePex, a non surgical device for adult male circumcision.


METHODS
A prospective study, conducted at International Hospital Kampala, Uganda, between August and October 2012. Ethical approval was obtained from Uganda National Council of Science and Technology.


RESULTS
Of 1,040 men received to undergo SMC, 678 opted for PrePex, 36 were excluded at an initial physical examination screening. 642 were enrolled and consented, and another 17 were excluded before device placement. 625 underwent the procedure. Average age was 24 years (± 7). Twelve moderate AEs occurred among 10 participants 12/625, (1.9%). These were all reversible. Five had device displacement, one had an everted foreskin; five had bleeding after the device was removed and one had voiding difficulties. The majority (279 out of 300) of men interviewed complained of some pain within the week of placement. Mean pain score at device placement (using visual analogue scale) was 0.5, at device removal 4.5 and within 2 min of removal the pain score was 1.4. Over 70% of the devices were placed and removed by non-physician clinicians. Presented with a choice, 60% of men chose PrePex over surgical SMC. Close to 90% would recommend the device to their friends. Odour from the necrotic skin was a concern. Removals done 1-2 days earlier than day 7 were beneficial and conferred no extra risk.


CONCLUSIONS
AEs of a moderate or severe nature associated with PrePex were low and reversible. PrePex is feasible for mass safe male circumcision scaling up.
International Hospital Kampala, Kampala, Uganda ; Surgery Department, Mulago Hospital, Kampala, Uganda.
Moses
M
Galukande
International Medical Group, Kampala, Uganda.
Kevin
K
Duffy
Kanombe Hospital, Kigali, Rwanda.
Jean Paul
JP
Bitega
International Hospital Kampala, Kampala, Uganda.
Sam
S
Rackara
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Denis Sekavuga
DS
Bbaale
International Health Sciences University, Kampala, Uganda.
Florence
F
Nakaggwa
International Health Sciences University, Kampala, Uganda.
Teddy
T
Nagaddya
International Health Sciences University, Kampala, Uganda.
Nick
N
Wooding
Centre of Disease Control, Kampala, Uganda.
Monica
M
Dea
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
Alex
A
Coutinho
D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects*; D002947:Cities; D004864:Equipment and Supplies / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014454:Uganda; D055815:Young Adult