{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T23:01:08Z","timestamp":1788908468268,"version":"build-2803163510"},"reference-count":39,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T00:00:00Z","timestamp":1758758400000},"content-version":"unspecified","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1158451"],"award-info":[{"award-number":["OPP1158451"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,8,27]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"\n Introduction<\/jats:title>\n Male circumcision (MC) has been shown to decrease transmission of HIV and is a critical strategy to decrease its incidence in countries with high rates of heterosexually transmitted HIV. Early infant MC (EIMC), with single-use MC devices, could increase rates of MC in Sub-Saharan Africa. Our objective was to determine the safety, efficacy and satisfaction of ShangRing EIMC in resource-constrained environments.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Healthy male infants aged 1\u201360\u2009days underwent ShangRing EIMC performed by non-physician clinicians in 14 sites in Kenya, Tanzania and Uganda. The primary outcomes were the safety and efficacy of ShangRing EIMC. Secondary outcomes were pain related to the procedure, wound healing and parental satisfaction. Male infants were assessed at discharge and on postoperative days 7 and 28 for wound healing and complications. This trial is registered with Clinical.Trials.gov,\n NCT03338699<\/jats:ext-link>\n , and is complete.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From the 1697 participants enrolled from February to November 2020, 1691 (99.6%) underwent ShangRing EIMC. Median duration of the procedure was 10\u2009min (IQR 6\u201313). The mean Neonatal Infant Pain Scale 20\u2009min postprocedure was 0.3 (SD 0.8), indicating no pain. At the time of discharge, 1679 (99.0%) participants had a normal-appearing wound and 1574 (93.1%) demonstrated complete wound healing at 28 days. A total of 17 (1.0%) AEs were reported, most related to bleeding. A total of 1635 (99.1%) of parents were satisfied with the appearance of the circumcised penis at 28 days.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n ShangRing EIMC is a simple and successful MC method that non-physician clinicians can perform safely, with low AE rate, satisfactory wound healing and high satisfaction rate among parents. This indicates that the ShangRing EIMC can be considered a long-term strategic approach to accelerate the scale-up of MC in Sub-Saharan Africa.<\/jats:p>\n <\/jats:sec>\n \n Trial registration number<\/jats:title>\n \n NCT03338699<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-017903","type":"journal-article","created":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T09:25:15Z","timestamp":1758792315000},"page":"e017903","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Safety and efficacy of the ShangRing for early infant male circumcision in the routine clinical setting"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03338699","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03338699","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03338699","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3038-0011","authenticated-orcid":false,"given":"Lina","family":"Posada Calderon","sequence":"first","affiliation":[{"name":"Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon P","family":"Basourakos","sequence":"additional","affiliation":[{"name":"Mayo Clinic Minnesota Department of Urology, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karla V","family":"Ballman","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaylee","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A","family":"Barone","sequence":"additional","affiliation":[{"name":"Population Council Center for Biomedical Research, New York, New York, USA"},{"name":"Bill & Melinda Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quentin","family":"Awori","sequence":"additional","affiliation":[{"name":"Population Council Kenya, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ouma","sequence":"additional","affiliation":[{"name":"Population Council Kenya, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jairus","family":"Oketch","sequence":"additional","affiliation":[{"name":"Homa Bay Teaching and Referral Hospital, Homa Bay, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Christensen","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5095-1483","authenticated-orcid":false,"given":"Augustino","family":"Hellar","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania, United Republic of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maende","family":"Makokha","sequence":"additional","affiliation":[{"name":"Jhpiego Tanzania, Dar es Salaam, Tanzania, United Republic 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Sciences Program, Kalisizo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggrey","family":"Anok","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina","family":"Nakabuye","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Ddamulira","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silas","family":"Odiya","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program, Kalisizo, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip S","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard K","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Urology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, 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for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations - policy brief. Geneva World Health Organization; 2020."},{"key":"2025092502251002000_10.9.e017903.5","unstructured":"World Health Organization and UNAIDS . Assessing and enhancing sustainable voluntary medical male circumcision services for HIV prevention in East and Southern Africa: a landscape report of voluntary medical male circumcision priority countries. 2023. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240072312"},{"key":"2025092502251002000_10.9.e017903.6","unstructured":"World Health Organization . WHO progress brief: voluntary medical male circumcision for HIV prevention. 2018. Available: https:\/\/www.afro.who.int\/sites\/default\/files\/2018-10\/29%20Oct_18145_Progress%20Brief_VMMC%202018.pdf?ua=1&utm_source=chatgpt.com"},{"key":"2025092502251002000_10.9.e017903.7","unstructured":"Nekesa Wepukhulu A . The role of traditional male circumcision in moral transmission among African communities. Iconic Res Eng J 2024;7. 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