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Single-Arm Evaluation of the AccuCirc Device for Early Infant Male Circumcision in Botswana

Plank, Rebeca M. MD, MPH*,†,‡; Wirth, Kathleen E. ScD‡,§; Ndubuka, Nnamdi O. MB, BS, Dip HIV Man (SA), MPH; Abdullahi, Rasak MD; Nkgau, Maggie RN; Lesetedi, Chiapo MB, CHb, BAO(NUI), AFRCSI(RCSI); Powis, Kathleen M. MD, MPH†,‡,#; Mmalane, Mompati MD; Makhema, Joseph MB, CHb, FRCP (UK); Shapiro, Roger MD, MPH†,‡,**; Lockman, Shahin MD, MSc*,†,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2014 - Volume 66 - Issue 1 - p 1–6
doi: 10.1097/QAI.0000000000000136
Rapid Communication

Abstract: Existing devices for early infant male circumcision (EIMC) have inherent limitations. We evaluated the newly developed AccuCirc device by circumcising 151 clinically well, full-term male infants with birth weight ≥2.5 kg within the first 10 days of life from a convenience sample in 2 hospitals in Botswana. No major adverse events were observed. There was 1 local infection, 5 cases of minor bleeding, and 1 case of moderate bleeding. In 3 cases, the device made only partial incisions that were completed immediately by the provider without complications. Parental satisfaction was high: >96% of mothers stated that they would circumcise a future son. The pre-assembled, sterile AccuCirc kit has the potential to overcome obstacles related to supply chain management and on-site instrument disinfection that can pose challenges in resource-limited settings. In our study, the AccuCirc was safe and it should be considered for programmatic EIMC in resource-limited settings.

*Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, MA;

Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA;

Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research and Education, Gaborone, Botswana;

§Department of Epidemiology, Harvard School of Public Health, Boston, MA;

Northern Inter-Tribal Health Authority, Prince Albert, Saskatchewan, Canada;

Botswana Ministry of Health, Gaborne, Botswana;

#Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA; and;

**Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA.

Correspondence to: Rebeca M. Plank, MD, MPH, Division of Infectious Diseases, Brigham and Women's Hospital, Department of Medicine, 15 Francis Street, PBB-A-4, Boston, MA 02115 (e-mail:

Supported by Grant U2GPS000941; the National Institute of Health Grant K23 AI084579.

The authors have no conflicts of interest to disclose.

Received November 18, 2013

Accepted January 24, 2014

© 2014 by Lippincott Williams & Wilkins