Safety, acceptability of Shang Ring in focus
Findings of a small study indicate that Shang Ring, a device in development, is safe and acceptable to men, which might aid in increasing access to voluntary adult male circumcision in areas at high risk of HIV.1
The Shang Ring, manufactured by Wu Hu SNNDA Medical Treatment Appliance Technology Co., Wu Hu City, China, is a disposable circumcision device consisting of two concentric plastic rings. Its design eliminates the need to make scalpel cuts directly on the penis. The latest finding by researchers from EngenderHealth in New York City, Weill Cornell Medical College in New York City, FHI 360 in Research Triangle Park, NC, and Homa Bay District Hospital in Kenya, Africa, confirms that the Shang Ring is safe to use and demonstrates that should men exceed the recommended timing for removing the device, there are no serious consequences.
Look for more data to emerge from analysis of the ring as a potential circumcision device, says Mark Barone, DVM, MS, senior clinical advisor at EngenderHealth and lead author of the current research paper. Investigators have completed a randomized study, which looked at men using the Shang Ring versus conventional circumcision. At press time, results were scheduled to be presented at the XIX International AIDS Conference in July 2012.2 Scientists also have finished a larger demonstration study with some 1,000 men in Kenya and Zambia, which examined potential adverse events associated with ring use, he states.
Such investigations are needed for the Shang Ring to be included in guidance from the Geneva, Switzerland-based World Health Organization (WHO) as an accepted device for adult male circumcision.
Now that research has proven that voluntary adult medical male circumcision reduces heterosexual transmission of HIV from women to men by approximately 60%3-5, countries that have a high HIV burden and a low proportion of circumcised men are looking for intervention options. Reaching large numbers of men with voluntary adult medical male circumcision services will require innovations, including simpler and quicker methods that are safe, says the WHO.6
Through a grant to FHI 360 from the Seattle-based Bill & Melinda Gates Foundation, EngenderHealth and Cornell are working with FHI 360 to study how the Shang Ring could transform the provision of male circumcision services in Africa. The current research paper could not have been successful without the support and active participation of Kenyan researchers, and especially the male circumcision team in Homa Bay, said David Sokal, MD, a scientist at FHI 360.
Easy to use
The current published study results affirm that acceptability is very high among men having a circumcision with the Shang Ring, said Philip Li, MD, associate research professor of urology, and reproductive medicine at Weill Cornell Medical College and director of microsurgical research and training at Cornell's Institute for Reproductive Medicine. The data also indicates that delaying removal of the ring poses no adverse risks, Li noted in a release accompanying the paper's publication. Unlike surgical circumcision that requires only one visit, the procedure done with the Shang Ring requires that the device stay in place for seven days after the procedure.
Clinicians who performed male circumcision using the Shang Ring said the method was 'very easy' compared to a conventional surgical technique, researchers note.
"One of the beauties of the Shang Ring is the quick time of the procedure," Barone observes. "The procedure time is very, very short relative to the time of the conventional techniques, meaning that many more men can be circumcised in a shorter period of time. Also the skill level that is required for the Shang Ring is also less than that required for the conventional procedures."
References
- Barone MA, Awori QD, Li PS, et al. Randomized trial of the Shang Ring for adult male circumcision with removal at one to three weeks: delayed removal leads to detachment. J Acquir Immune Defic Syndr 2012; 60(3):e82-89.
- Sokal DC, Awori Q, Barone M, et al. Randomized controlled trial of the Shang Ring versus conventional surgical techniques for adult male circumcision in Kenya and Zambia. Presented at the XIX International AIDS Conference; Washington, DC. July 2012.
- Auvert B, Taljaard D, Lagarde E, et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 trial. PLoS Medicine 2005; 2:e298.
- Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007; 369(9562):643-656.
- Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet 2007; 369(9562):657-666.
- World Health Organization. Use of Devices for Adult Male Circumcision in Public Health HIV Prevention Programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision. Geneva; March 2012.
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