The government plans to circumcise two million men in the next two years in an ambitious mass program that aims to reduce HIV transmission rate by 50 percent.

Tzamaret Fuerst, CEO of PrePex demonstrates the PrePex male circumcision device. (Internet photo

This follows success­ful trials of a non-surgical method of male circumci­sion called Prepex which experts say is easy to use and appropriate for the rural settings. Male cir­cumcision has tradition­ally been performed sur­gically.

Prepex device is a sim­ple non-surgical method that requires no sterile setting, no injected anes­thesia, and it’s a blood­less procedure with no need for sutures.

PrePex has an elastic mechanism that fits close­ly around an inner ring, trapping the foreskin, which dries up and is re­moved a week after the placement of the device.

“The Ministry of Health has carried out clinical trials to evaluate this new device for one and a half years,” said Dr Vincent Mutabazi, the lead in­vestigator in the PrePex clinical trials in Rwanda. “After three major clini­cal trials required by the World Health Organiza­tion technical advisory group that reviews inno­vations on male circum­cision devices, we see strong and compelling evidence on the safety, superiority over surgical circumcision and simplic­ity in the hand of lower cadre health practitioners like nurses.”

During the trials, Pre­Pex circumcision device was found to be five times faster than surgical because it is bloodless, re­quires no anesthesia, no sutures and no sterile set­tings as compared to the surgical procedure.

PrePex has an elastic mechanism that fits closely around an inner ring, trapping the foreskin, which dries up and is removed a week after the placement of the device.

The procedure is sim­pler to use as it only re­quires ample dexterity in the hands of the user, said Mutabazi.

“During this clinical trial the PrePex male cir­cumcision device show considerable less adverse effects in comparison to the surgical method,” Mutabazi added.

The components of Prepex.

In March 2007 during a meeting in Montreux, WHO/UNAIDS recom­mended that male cir­cumcision be promoted as part of a comprehensive HIV prevention pack­age. It was also agreed that countries with gen­eralized heterosexual epi­demics and low male cir­cumcision rates be a focus for scaling up this inter­vention studies in Africa showed that male circum­cision can reduce the risk of contracting HIV by 53%–60%.

There are some chal­lenges in reaching all the people that need to be circumcised, especially in sub-Saharan Africa, as Mutabazi pointed out. “There are no sufficient health facilities and qual­ified personnel to handle mass circumcision pro­grams. The PrePex device has the potential to facili­tate rapid male circumci­sion scale-up programs for HIV prevention, an imminent need in Sub Sa­haran Africa.”

The minister of health, Dr Agnes Binagwaho said that WHO is expected to approve the use of Pre­Pex system after a review of clinical data that has been provided. “There is no need for a sterile environment to proceed with it and even nurses can use it,” she said. It only takes 3 days to train people how to use the de­vice whereas only highly trained and skilled medi­cal personnel can perform surgical circumcision.

The PrePex male cir­cumcision device is also being tested in Zimba­bwe. “We have submitted the reports on our studies to the WHO technical ad­visory group and expect a response in one month time,” added Mutabazi.

Dr Leon Ngeruka, who practices at the Kanombe Military Hospital praised the new system:

“Although it is still in its testing phase, most people preferred it to the surgical circumcision and if it is approved it may be the first choice for every­one.”

The targeted group for the nationwide voluntary medical male circumci­sion program is men be­tween 15 and 49 years old.