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December 02, 2013

Male Circumcision without Surgeon Offers Hope of AIDS-Free Generation in Rwanda

by Kim Lewis

Rwanda’s Ministry of Health announced a major nationwide expansion of non-surgical adult male circumcisions as part of its strategies to reduce HIV/AIDS infections.  A device called a PrePex was recently cleared for use. It will enable up to 700,000 men between the ages of 15 and 49 to be circumcised across the country.  The device could revolutionize the way traditional circumcisions are perceived and performed. It will also save lives. 
 
Six years ago, the World Health Organization and UNAIDS set a goal to have 20 million adult men voluntarily circumcised by the year 2015.  It was part of an effort to reduce heterosexually acquired HIV/AIDS.  The goal was based on clinical research that showed that an estimated 3.5 million lives would be saved, along with a savings of $16.5 million in long-term healthcare costs. To reach the target, a scaling-up process was needed.
 
Tzameret Fuerst is co-founder and president of Circ MedTech, the developer of the PrePex device, a non-surgical means to circumcise men. She said to date, about ten percent of the target goal has been met, and that they now have about two years to achieve the 20-million mark by 2015.
 
“On the supply side, Africa lacks the surgical infrastructure and human resources to scale up a surgical procedure,” said Fuerst. She offers the example of Rwanda, which has an 11 million people and only 582 physicians.  “So it’s a real challenge for them to leverage the very few surgeons they have to scale up the surgical procedures. 
 
“On the demand side, it is a tough sell to get men, healthy men, into a clinic when they have to undergo a surgical procedure and they’re fearful of the blood, and then the injections, and the loss of work,” said Fuerst.

Listen to interview on expansion of Rwanda male circumcision campaign

Fuerst said those challenges motivated her company to create the PrePex device.
 
Pain-free procedure rural nurses can perform

“The PrePex actually addresses these concerns.  And what we’ve created is the first device in the world that can conduct non-surgical adult male circumcisions. And what that means, is that the procedures are conducted with no injected anesthesia.  It is completely bloodless; it entails no suturing, no sterile settings, no electricity, no physicians, no hospitals,” explained Fuerst. 
 
Circ MedTech president Tzameret Fuerst celebrates launch of PrePex at a Rwandan clinic (Courtesy Circ MedTech)
​​The Circ MedTech executive said a nurse with only three days of training can perform the procedure in a non-hospital setting. Fuerst explained that the PrePex works in the same way as an umbilical cord removal from a new-born infant.
 
“If you recall, you clamped the umbilical cord and you stopped the flow of blood and oxygen to the unwanted tissue.  So, that’s exactly what we’re doing to the unwanted foreskin tissue.  So by applying radial elastic pressure, for a very special elastic ring, on top of a rigid inner-ring that goes under the foreskin, we’re essentially stopping the flow of blood and circulation to the unwanted foreskin tissue.” The tissue dies within a few hours and in a week it dries up.  She said it can be removed like you’re going to cut your finger nails.
 
Testing expanded in other African countries

She added the men actually wear the device for six to seven days.  They are able to go back to work and go on with their daily lives after placement and removal of it. For the past three years, Rwanda has pioneered this new approach. Other countries testing PrePex include Uganda, South Africa, Zimbabwe, Botswana and Mozambique, the Gambia, and Kenya.
 
Fuerst said this non-surgical approach “will completely change the terminology of what is possible in scaling up of adult male circumcision because we’re addressing the key concerns of many men - of why they’re not stepping up to get circumcised.”
 
The campaign to rid a generation of HIV/AIDS has made great progress in improving access to treatment and the prevention of mother-to-child transmission.  Many health officials believe scaling up non-surgical adult male circumcision will be a big step toward achieving an AIDS-free world and that this new non-surgical device will help to reach that goal.