Voluntary male medical circumcision of pre-school-aged boys in primary care

Abstract

Voluntary medical male circumcision (VMMC) is a priority human immunodeficiency virus (HIV) preventive intervention. Challenges in funding national VMMC programmes mandate us to adopt new methods to provide circumcisions in a primary care setting. This study aims to test the practicality of instrument-assisted circumcision in primary care in pre-school-age boys. The study setting was one primary care centre in Western Cape, South Africa. The methodology adopted is prospective case series of minimally invasive voluntary circumcision using the Unicirc instrument in boys less than 6 years of age. We circumcised 221 healthy boys using the Unicirc instrument, using a combination of topical anaesthetic, subcutaneous local anaesthetic and intramuscular ketamine. There were 5 (2.3%) mild complications and 48 (21.7%) had mucosal swelling as a result of lysis of physiological phimosis. All boys were fully healed at 2 weeks and all caregivers were highly satisfied. Using a circumcision instrument in primary care simplifies circumcision in pre-school-age boys and has a low rate of adverse events. This study demonstrates that a new model of circumcision in primary care may enhance national VMMC programmes.