Non-surgical Adult Male Circumcision Using the PrePex Device: Task-Shifting from Physicians to Nurses

Vincent Mutabazi, Jean P. Bitega, Leon M. Ngeruka, Theobald Hategekimana, Steven A. Kaplan, Corine Karema, Agnes Binagwaho

Abstract

The Republic of Rwanda is implementing a program of voluntary male circumcision (MC) to reduce HIV transmission but lacks the infrastructure for conventional surgical MC on a nationwide scale. Nonsurgical MC using the PrePex device was first assessed in 5 subjects on an inpatient basis. Subsequent procedures were on an outpatient basis. Physicians performed 100 outpatient procedures (Phase 1 of this study) and trained nurses in the technique; the nurses then independently performed 47 procedures (Phase 2). All subjects achieved complete circumcision and healing within 6 weeks. There were no cases of infection or bleeding. In Phase 1, one case of transient moderate diffuse edema occurred. In Phase 2, no adverse events were reported. Thus, outcomes of MC performed by nurses using the PrePex device were not inferior to outcomes achieved by physicians, suggesting that task-shifting MC by this method from physicians to nurses is feasible in Rwanda. (Afr J Reprod Health 2014; 18[1]: 61-70).

 

Keywords: Circumcision, device, nurses, Rwanda, safety, task-shifting

 

Résumé

La République du Rwanda met en œuvre un programme de circoncision masculine volontaire (CM) pour réduire la transmission du VIH, mais n'a pas l'infrastructure pour la CM chirurgicale classique à l'échelle nationale. CM non chirurgicale en utilisant le dispositif PrePex a été évaluée pour la première fois en cinq sujets  en milieu hospitalier. Les procédures postérieures ont été basées sur une consultation externe. Les médecins ont effectué 100 interventions basées sur les consultations externes (phase 1 de cette étude) et ont formé les infirmières formés dans la technique ;  les infirmières, à leur tour, ont effectuées indépendamment 47 procédures (phase 2). Tous les sujets atteints une circoncision complète et la guérison dans 6 semaines.  Il n’y avait aucun cas d'infection ou de saignement. Dans la phase 1, un cas  d’œdème modéré diffuse transitoire s'est produit. Dans la phase 2, aucun effet indésirable n'a été signalé. Ainsi, les résultats de CM effectuées par des infirmières à l’aide du dispositif PrePex n'étaient pas inférieurs aux résultats obtenus par les médecins, ce qui suggère que la délégation des tâches des CM par cette méthode de la part des médecins aux infirmières est possible au Rwanda. (Afr J Reprod Health 2014; 18[1]: 61-70).

 

Mots clés: circoncision, dispositif,  infirmières,  Rwanda, sécurité,  délégation des tâches 

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References

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