Barcelona 2013
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| Abstract #590 - Biomedical Prevention | ||||
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Session: 40.8: Biomedical Prevention (Parallel) on Tuesday @ 16.30-18.30 in Raval Chaired by Olive Shisana, Chinese Authors: Presenting Author: Dr Danuta Kasprzyk - Battelle, United States |
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| Additional Authors: Dr. Prashant Sharma, Dr. Manorama Bhargava, | ||||
| Aim: Male circumcision (MC) substantially reduces female to male transmission of HIV. MC programs in 14 priority countries have only circumcised about 10% of target men. Thus, countries are seeking innovative supply-side solutions for scaling up MC. Devices, especially those that eliminate full surgical procedures and that can be used by broader cadres of clinicians, may offer better dissemination of MC services. One device, the PrePexTM, uses a plastic ring with a rubber O-ring to necrotize the foreskin. A three phase trial of this device was carried out in Zimbabwe. Phase II was a comparative study to compare performance of surgical to device MCs. Clinical, psychosocial, and sexual outcomes were measured. Uptake of MC depends on men having positive experiences and spreading the word about them, thus it is important to assess these factors. Information is also provided to plan counseling messages, and evidence-based communications to address experiences men may have. | ||||
| Method / Issue: The Comparative Study Phase was a randomized, open label, trial comparing the performance of the non-surgical device to surgical MC in healthy adult men; among 242 men. After recruitment, men were randomized to either device or surgical MC in a 2:1 ratio; 2 device to 1 surgical. This phase measured: 1) Demographics; 2) VMMC experience, conversations and information sources; 3) Direct and indirect attitudes re VMMC; 4) Social norms re VMMC; 5) Activities of daily living; 6) Experiences post-procedure; 7) Satisfaction with process and results of the circumcision; 8) Sexual history and current sexual activities; 9) Attitudes toward sex; 10) Attitudes toward condom use with different partners; and 11) Perception of HIV risk over lifetime. Men were surveyed prior to their MC, and 2-weeks and 90-days post MC. | ||||
| Results / Comments: Men indicated that most of their MC information came from TV/radio (72%), newspapers/billboards (34%) and friends/colleagues (20%). On average men talked to only 1 or 2 people before their MCs, but at 2-weeks, the median number increased to 5; and at 90-days to 8. Men were very satisfied with their MCs; satisfaction increased over time, with no significant differences between device and surgical MC groups. Men in the device group reported significantly more pain, than men in the surgical group (p<.05). On most the outcomes listed above, men in the groups did not differ significantly in their ratings, including in effects on daily living, and time off work. Men reported that they expected much more of an effect of the MC on their work time off than actually occurred. Anxiety about the procedure increased significantly over time for both groups (p<.05), but peaked at 2-weeks for device men, versus 90-days for surgical MC men. | ||||
| Discussion: Men report positive outcomes with both surgical and device MC including minimal negative effects on all outcomes assessed. The pain experience among device circumcised men needs to be better managed via more explicit counseling about expectations. Based on the number of people men talk to, there is a risk that this unanticipated pain will act as a barrier for future adoption of MC among men who hear about it. | ||||
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