The Rwandan government plans to expand its national voluntary male circumcision programme using a new device, the PrePex system, which officials say saves both time and money.
The PrePex system works through a special elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed after a week. A study conducted by the Rwandan Ministries of Defence and Health in 2010 found the device to be safe and effective.
"You don't need a sterile environment, you don't need anaesthetic, you don't need to use an operating theatre," Agnes Binagwaho, permanent secretary in Rwanda's Ministry of Health, told IRIN/PlusNews. "It does not need highly trained medical personnel, and can be conducted in a clean consultation room with a bed.
"In Africa, where we lack medical infrastructure, we feel it is the best way to go," she added.
Although cost-effectiveness studies are still under way, Binagwaho said the elimination of factors such as anaesthetic and highly trained staff as well as the gains made by the shorter healing time meant it was likely that the PrePex system would be cheaper than traditional clinical male circumcision.
"Three or four hours after circumcision, a man can be back at work," she said. "This means that the economy does not suffer because men have taken several days off work to heal."
She noted that while the UN World Health Organization (WHO) had not approved any device for adult male circumcision, the PrePex system is approved by the European Union.
"We are still waiting to see the data showing the efficacy, safety and acceptability of the device," Tim Farley, a scientist with the WHO’s Department of Reproductive Health and Research, told IRIN/PlusNews. "If the promise of the device is borne out by the data, we would be very keen to approve it."
Rwanda's HIV prevention strategy includes a plan to circumcise an estimated two million adult men within two years; only 15 percent of Rwandan men are circumcised, according to the government.
|The PrePex device is a game-changing innovation... a non-surgical technique with no local anaesthesia will make this technology accessible and scalable|
"The PrePex device is a game-changing innovation... the evidence from the study is very compelling – a non-surgical technique with no local anaesthesia will make this technology accessible and scalable," Steven Kaplan, a urologist New York's Cornell University and co-investigator of a current PrePex study in Rwanda, said in a press release.
WHO and UNAIDS recommend the inclusion of voluntary medical male circumcision in HIV prevention programmes, alongside counselling and testing, promotion of safer sex, treatment of sexually transmitted infections and condom use.
While surgical male circumcision remains the preferred method of most national male circumcision programmes in sub-Saharan Africa, a few countries - including Kenya and South Africa - have piloted the use of different clamps for adult male circumcision.
According to WHO's Farley, the body has approved the use of three different devices - the Mogen clamp, the Gomco clamp and the Plastibell - but only for infant circumcision.