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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.

Prepex-Tzamaret Fuerst

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.

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