title: Safety, Acceptability, and Feasibility of Early Infant Male Circumcision Conducted by Nurse-Midwives Using the AccuCirc Device: Results of a Field Study in Zimbabwe.
abstract: For prevention of HIV, early infant male circumcision (EIMC) needs to be scaled up in countries with high HIV prevalence. Routine EIMC will maintain the HIV prevention gains anticipated from current adult male circumcision initiatives. We present here the results of a field study of EIMC conducted in Zimbabwe.
  
  
  
  The study was observational and based on the World Health Organization (WHO) framework for clinical evaluation of male circumcision devices. We recruited parents of newborn male infants between August 2013 and July 2014 from 2 clinics. Nurse-midwives used the AccuCirc device to circumcise eligible infants. We followed participants for 14 days after EIMC. Outcome measures were EIMC safety, acceptability, and feasibility.
  
  
  
  We enrolled 500 male infants in the field study (uptake 11%). The infants were circumcised between 6 and 60 days postpartum. The procedure took a median of 17 minutes (interquartile range of 5 to 18 minutes). Mothers' knowledge of male circumcision was extensive. Of the 498 mothers who completed the study questionnaire, 91% knew that male circumcision decreases the risk of HIV acquisition, and 83% correctly stated that this prevention is partial. Asked about their community's perception of EIMC, 40% felt that EIMC will likely be viewed positively in their community; 13% said negatively; and 47% said the perception could be both ways. We observed 7 moderate or severe adverse events (1.4%; 95% confidence interval, 0.4% to 2.4%). All resolved without lasting effects. Nearly all mothers (99%) reported great satisfaction with the outcome, would recommend EIMC to other parents, and would circumcise their next sons.
  
  
  
  This first field study in sub-Saharan Africa of the AccuCirc device for EIMC demonstrated that EIMC conducted by nurse-midwives with this device is safe, feasible, and acceptable to parents.
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe University College London, London, United Kingdom.
authors.forename: Webster
authors.initials: W
authors.lastname: Mavhu
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Natasha
authors.initials: N
authors.lastname: Larke
authors.affiliation: Population Services International, Harare, Zimbabwe khatzold@psi-zim.co.zw.
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Getrude
authors.initials: G
authors.lastname: Ncube
authors.affiliation: London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.
authors.forename: Collin
authors.initials: C
authors.lastname: Mangenah
authors.affiliation: Harare City Health, Harare, Zimbabwe.
authors.forename: Prosper
authors.initials: P
authors.lastname: Chonzi
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Owen
authors.initials: O
authors.lastname: Mugurungi
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.
authors.forename: Juliet
authors.initials: J
authors.lastname: Mufuka
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Samkange
authors.affiliation: Ministry of Health and Child Care, Harare, Zimbabwe.
authors.forename: Gerald
authors.initials: G
authors.lastname: Gwinji
authors.affiliation: Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe University College London, London, United Kingdom.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.affiliation: University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
authors.forename: Ismail
authors.initials: I
authors.lastname: Ticklay
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000009:adverse effects / Q000295:instrumentation* / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009721:Nurse Midwives; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data*; D055815:Young Adult; D015030:Zimbabwe