Randomized Trial of the Shang Ring for Adult Male Circumcision With Removal at One to Three Weeks: Delayed Removal Leads to Detachment

Abstract

To assess healing with Shang Ring removal at different prespecified times; whether spontaneous detachment occurs with delayed removal; problems, complaints, and acceptability of wearing the device; satisfaction among participants; and acceptability of the procedure among providers. Methods: Fifty HIV-negative men underwent a Shang Ring circumcision in Kenya. Men were randomly assigned for device removal at 7 (15 men), 14 (15 men), or 21 days (20 men). Followup visits were at 7, 14, 21, 28, and 42 days after circumcision and 2 days after removal. Results: Circumcision and device removal were conducted without significant problems. Mean times for circumcision and device removal were 6.5(SD = 2.4) and2.5(SD = 0.8) minutes, respectively. Complete detachment of the device occurred in 22 (66.7%) men who wore it more than 7 days. Seven men (14.0%) with partial detachments requested removal 8–14 days post circumcision due to pain/discomfort. Healing progressed normally in all participants;cumulative probabilities of complete healing were similar across groups. No severe or serious adverse events occurred. Acceptability among participants was high. Providers reported that Shang Ring circumcision was“very easy” compared with the forceps-guided procedure. Conclusion: The Shang Ring is safe and easy to use according to label instructions (7 day removal). Detachments occurred without significant problems, although some men requested removal of partially detached rings. Removal time had little effect on healing. These data help allay concerns about men not returning for ring removal and expand the evidence base suggesting the Shang Ring could facilitate rapid male circumcision rollout in sub-Saharan Africa.