title: Surgical Outcomes of Newly Trained ShangRing Circumcision Providers.
abstract: BACKGROUND
  Devices can potentially accelerate scale-up of voluntary medical male circumcision in sub-Saharan Africa. Studies have demonstrated advantages of the ShangRing device over conventional circumcision. With the need to train providers rapidly for scale-up, concerns arise about the transferability of techniques and the expertise of new trainees.
  
  
  METHODS
  We compared outcomes of ShangRing circumcisions conducted in Kenya by experienced providers (experience with more than 100 ShangRing circumcisions) and newly trained providers (trained in Kenya by the experienced providers before the study began). During training, trainees performed at least 7 ShangRing circumcisions and 3 removals. Newly trained providers received intermittent clinical mentoring initially during the study but otherwise conducted circumcisions on their own.
  
  
  RESULTS
  Four hundred six and 115 ShangRing procedures were performed by the new trainees and the experienced providers, respectively. The mean duration of circumcisions was 6.2 minutes for both trained and experienced provider groups (P = 0.45), whereas the mean pain score (on an 11-point scale) was 2.5 and 3.2, respectively (P = 0.65). There was no difference in the proportion of participants healed by the day 42 visit (P = 0.13) nor in the incidence of moderate and severe adverse events observed (P = 0.16). Participants in both groups were equally satisfied with final wound cosmesis.
  
  
  CONCLUSIONS
  Results demonstrate that the ShangRing circumcision technique is easy to learn and master. Newly trained providers can safely conduct ShangRing circumcisions in routine service settings. The ShangRing can facilitate rapid rollout of voluntary medical male circumcision for HIV prevention in sub-Saharan Africa.
authors.affiliation: *ShangRing Research, EngenderHealth, Nairobi, Kenya; †Center for Male Reproductive Medicine and Surgery, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; ‡Department of Urology, University Teaching Hospital, Lusaka, Zambia; §VMMC programme, Impact Research & Development Organization, Kisumu, Kenya; ‖Clinical Sciences Unit, FHI 360, Durham, NC; ¶Surgical Department, Homa Bay District Hospital, Homa Bay, Kenya; #ZPCT, FHI 360, Lusaka, Zambia; and **Clinical Research, EngenderHealth, New York, NY.
authors.forename: Quentin D
authors.initials: QD
authors.lastname: Awori
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Philip S
authors.initials: PS
authors.lastname: Li
authors.forename: Robert
authors.initials: R
authors.lastname: Zulu
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.forename: Stephanie
authors.initials: S
authors.lastname: Combes
authors.forename: Raymond O
authors.initials: RO
authors.lastname: Simba
authors.forename: Catherine
authors.initials: C
authors.lastname: Hart
authors.forename: Jaim Jou
authors.initials: JJ
authors.lastname: Lai
authors.forename: Zude
authors.initials: Z
authors.lastname: Zyambo
authors.forename: Marc
authors.initials: M
authors.lastname: Goldstein
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Feldblum
authors.forename: Mark A
authors.initials: MA
authors.lastname: Barone
mesh_terms: D002944:Circumcision, Male / Q000009:adverse effects / Q000295:instrumentation*; D015658:HIV Infections / Q000517:prevention & control*; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D016896:Treatment Outcome; D015024:Zambia