Population Council Research that makes a difference

Kenya National AIDS Control Council
First National Biennial HIV and AIDS Research Conference
17–20 May 2011

Abstract

"The Shang Ring for adult male circumcision: Evaluation of healing at three time intervals"
Quentin Awori, Mark A. Barone, Philip S. Li, Raymond Otieno Simba, Mark Weaver, Peter Cherutich, Nicholas Muraguri, John Masasabi Wekesa, Jared Nyanchoka, Paul Perchal, Puneet Masson, Richard Lee, Marc Goldstein, and David C. Sokal

Background
Our objective was to assess time to complete healing following the Shang Ring adult male circumcision with ring removal at 7, 14, or 21 days postcircumcision.

Methods
Fifty HIV-negative men underwent a Shang Ring circumcision at the Homa Bay District Hospital. Men were randomly assigned for ring removal at 7, 14, or 21 days after circumcision. Follow-up visits were at 7, 14, 21, 28, and 42 days after circumcision, with an additional visit two days after removal. Healing and adverse events were assessed at follow-ups.

Results
Complete healing was observed in 46/50 (92.0%) men; two were lost to follow-up before complete healing and two were not completely healed by 42 days. No complete healing was observed at 7 or 14 days. Differences in the cumulative probability of complete healing among randomization groups were not significant (p=0.86) (Table 1).

Table 1. Kaplan-Meier estimates of cumulative probability of complete healing (95% CI)

	Randomization group
Visit day	Day 7 removal	Day 14 removal	Day 21 removal
21	13.3% (3.5%, 43.6%)	13.3% (3.5%, 43.6%)	20.0% (8.0%, 44.9%)
28	60.0% (37.2%, 83.5%)	71.1% (47.2%, 91.0%)	70.0% (49.9%, 87.7%)
42	100.0% (100.0%, 100.0%)	90.4% (66.2%, 99.4%)	94.0% (76.4%, 99.6%)

Complete healing tended to be sooner when rings were removed after 7 days, although differences were not significant (p=0.18). For example, cumulative probability (95% CI) of complete healing at 28 days was 52.9% (32.0%, 77.0%) versus 74.8% (59.1%, 88.1%) for ring removal at 7 days versus later, respectively. Seven men, all in the 14- and 21-day groups, requested early removal due to pain/discomfort associated with partial ring detachment.

Conclusions
Results suggest that ring removal at later times following adult male circumcision does not lengthen the time to complete healing, and that there are no serious consequences if men do not return on time for removal.

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