{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:53:18Z","timestamp":1791913998153,"version":"4.3.4"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084493"],"award-info":[{"award-number":["OPP1084493"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1084493"],"award-info":[{"award-number":["OPP1084493"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The World Health Organization (WHO) endorses male circumcision as an effective human immunodeficiency virus (HIV) prevention intervention in settings where the expected impact is greatest, including Sub-Saharan Africa. Data on cost implications of early infant male circumcision (EIMC) are limited. The ShangRing (SR) is a WHO pre-qualified device for circumcision. We sought to perform a comprehensive cost assessment alongside a randomized controlled trial (RCT) of the SR versus the standard of care Mogen clamp (MoC) for EIMC to enable future scale-up towards a cost-effective HIV prevention strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We collected resource utilization and economic data as part of an RCT of infants aged 0\u201360 days old undergoing EIMC in Kenya, Tanzania, and Uganda. Cost data for both the SR and MoC included baseline facility costs, direct costs, and indirect costs. The Decision Makers Program Planning Tool v1.0 was used to perform a direct cost comparison of these two devices. The Goals model was used to compare the costs of EIMC in 2023 using the present value of money to circumcise an adolescent male 15 years from now.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 1,378 infant males underwent circumcision, 689 via SR and 689 via MoC. The overall cost of a single EIMC in Kenya, Tanzania, and Uganda were 61.30 United States Dollars ($), $47.14, and $64.59 respectively for the SR, and $56.38, $50.43, and $58.57 respectively for the MoC. In Kenya, EIMC would be less expensive based on nominal present costs in 2023 compared to waiting for adolescent circumcision at age 15 years in 2038. This finding is reversed in Tanzania and Uganda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The overall cost of EIMC via SR versus MoC is comparable in an RCT. With scale-up utilizing lower level personnel, the cost of SR may be further reduced. The SR is an attractive alternative for future EIMC initiatives in Sub-Saharan Africa to further reduce HIV burden.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0360356","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T17:29:53Z","timestamp":1791912593000},"page":"e0360356","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cost comparison of the ShangRing device versus Mogen clamp for early infant male circumcision in Sub-Saharan Africa"],"prefix":"10.1371","volume":"21","author":[{"given":"Nahid","family":"Punjani","sequence":"first","affiliation":[{"name":"NewYork-Presbyterian\/Weill Cornell Medicine","place":["New York, New York, United States of America"],"department":["Department of Urology"]},{"name":"Mayo Clinic Arizona","place":["Phoenix, Arizona, United States of America"],"department":["Department of Urology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9087-9431","authenticated-orcid":true,"given":"Tenny R.","family":"Zhang","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian\/Weill Cornell Medicine","place":["New York, New York, United States of America"],"department":["Department of Urology"]},{"name":"Boston Children\u2019s Hospital","place":["Boston, Massachusetts, United States of America"],"department":["Department of Urology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon P.","family":"Basourakos","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian\/Weill Cornell Medicine","place":["New York, New York, United States of America"],"department":["Department of Urology"]},{"name":"Case Western Reserve University School of Medicine","place":["Cleveland, Ohio, United States of America"],"department":["Department of Urology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2335-9190","authenticated-orcid":true,"given":"Mark A.","family":"Barone","sequence":"additional","affiliation":[{"name":"The Population Council","place":["New York, New York, United States of America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Christensen","sequence":"additional","affiliation":[{"name":"Jhpiego","place":["Dar es Salaam, Tanzania"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Kigozi","sequence":"additional","affiliation":[{"name":"Rakai Health Sciences Program","place":["Entebbe, Uganda"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Goldstein","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian\/Weill Cornell Medicine","place":["New York, New York, United States of America"],"department":["Department of Urology"]},{"name":"The Population 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America"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard K.","family":"Lee","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian\/Weill Cornell Medicine","place":["New York, New York, United States of America"],"department":["Department of Urology"]},{"name":"The Population Council","place":["New York, New York, United States of America"]},{"name":"Weill Cornell Medicine","place":["New York, New York, United States of America"],"department":["Department of Population Health Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"7249","key":"pone.0360356.ref001","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1136\/bmj.320.7249.1592","article-title":"How does male circumcision protect against HIV infection?","volume":"320","author":"R 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