The Acceptability and Safety of the Shang Ring for Adult Male Circumcision in Rakai, Uganda

Abstract

Objectives Medical male circumcision (MMC) is recommended for HIV prevention in men. We assessed the acceptability and safety of the Shang Ring device compared to the dorsal slit method. Methods HIV-negative, uncircumcised men aged 18 years or older who requested free MMC services in rural Rakai, Uganda were informed about the Shang Ring and dorsal slit procedures and offered a free choice of procedure. Men were followed at 7 days postoperatively to assess adverse events (AEs) related to surgery and to remove the Shang Ring. Wound healing was assessed at 4 weeks postoperatively. Results 621 men were enrolled, of whom 508 (81.8%) chose the Shang Ring and 113 the dorsal slit. The Shang Ring was provided to 504 men, among whom there were 4 failures of Ring placement (0.8%) which required surgical hemostasis and wound closure. 500 men received the Shang Ring and postoperative surgery-related moderate AEs were 1.0%, compared to 0.8% among dorsal slit recipients. Complete wound healing at 4 weeks was 84% with the Ring and 100% with dorsal slit (p<0001). Resumption of intercourse before 4 weeks was 7.0% with the Ring and 15.0% with dorsal slit (p=0.01.) The mean time for surgery was 6.1 minutes with the Ring and 17.7 minutes with the dorsal slit. Mean time for Ring removal was 2.2 minutes. Conclusion The Shang Ring is highly acceptable and safe in this setting, and could improve the efficiency of MMC services. However, back up surgical services are needed in cases of Ring placement failures.

A Systematic Review and Meta-analysis of Circumcision With Shang Ring vs Conventional Circumcision

“…In our view, this process does not require flipping the foreskin, and there is no need to cut slits on the posterior edges of the foreskin. A non-RCT by Kigozi et al 27 reported that the mean surgical duration for SRC was 6.1 minutes, compared with 17.7 minutes for CC. Bratt and Zyambo 28 reported 13.4 minutes, on average, for SRC vs 24.3 minutes for CC.…”

Chinese Shang Ring Male Circumcision: A Review

“…Another study in Uganda enrolled 621 men; among them, 508 (82%) chose SC and 113 chose CC. Results of this study demonstrated that SC is highly acceptable and safe, and could improve the efficiency of MC services [34].…”

Trends in the Marginal Cost of Male Circumcision in Rural Rakai Uganda

“…To reduce overall program costs, cost saving strategies were employed including use of clinical officers (equivalent to physician’s assistants) [21] and research on use of the Shang Ring and PrePex devices, which require less time and equipment than conventional surgical procedures [22, 23]. …”