Background: The PrePex™ device offers an alternative to conventional surgical methods of male circumcision. Because it does not require injectable anesthesia or the cutting of vital tissue, PrePex™ requires less surgical capacity and may be more acceptable to men, potentially increasing uptake of this proven HIV prevention intervention. In May 2013, PrePex™ received WHO prequalification for adults aged 18 and above. Rwanda was the first country to conduct PrePex™ safety and acceptability studies and is now the first to scale-up PrePex™ in programmatic settings. PrePex™ currently comes in five adult sizes, A through E. Since 2009, Jhpiego, with PEPFAR funding through the US Department of Defense, has supported the Rwanda Defense Force (RDF) to provide VMMC to soldiers, their dependents and civilians living near base clinics. Since February 2014 PrePex™ has been offered alongside conventional surgery to adult VMMC clients at Jhpiego-supported RDF sites.
Methods: We reviewed routine program data from Jhpiego-supported RDF sites from program inception in October 2009 through August 2014.
Results: Between October 2009 and August 2014 86,284 adolescent boys and adult men were circumcised at Jhpiego-supported RDF sites, with 20,877 of these clients served in the seven months since PrePex™ was added. Since PrePex™ was introduced nearly two thirds of circumcisions have used the device, with 13,148 (63%) of clients receiving PrePex™ and 7,729 (37%) conventional surgery. Overall uptake has been increasing year to year; the number of clients served doubled from 2012 to 2013 thanks to efficiency approaches such as task shifting to nurses and use of mobile (outreach) teams. PrePex™ introduction appears to have accelerated this trend although in July 2014 the program experienced device stockouts especially in sizes A,D and E.
Conclusions: The introduction of the PrePex™ device in routine programmatic settings is well accepted by adult VMMC clients in Rwanda, with 63% of this age group choosing PrePex™. The acceptance rate would have likely have been higher if not for a stock out of PrePex™ devices beginning in July 2014. Programs planning to scale up PrePex™ should anticipate the supply chain implications of this device which is currently available in five adult sizes.
PrePex™ and Surgical VMMCs Conducted at Jhpiego-supported RDF Sites, Feb-Aug 2014