{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T06:08:59Z","timestamp":1763705339188,"version":"3.41.2"},"reference-count":37,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,7,12]],"date-time":"2017-07-12T00:00:00Z","timestamp":1499817600000},"content-version":"vor","delay-in-days":192,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"funder":[{"DOI":"10.13039\/501100004828","name":"Grand Challenges Canada","doi-asserted-by":"publisher","award":["0139\u201001"],"award-info":[{"award-number":["0139\u201001"]}],"id":[{"id":"10.13039\/501100004828","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of the International AIDS Society"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p><jats:bold>Introduction<\/jats:bold>: Male circumcision is a proven prevention strategy against the spread of HIV. The World Health Organization's new 2016\u20132021 strategic framework on voluntary medical male circumcision (VMMC) targets 90% of males aged 10\u201329\u00a0years to receive circumcision by 2021 in 14 priority sub\u2010Saharan countries while anticipating an increase in the demand for infant circumcision. It also states that the use of circumcision devices is a safe and efficient innovation to accelerate attainment of these goals. The primary objective of this pilot study was to evaluate the safety and acceptability of the ShangRing, a novel circumcision device, in boys below 18\u00a0years of age.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: A total of 80 boys, 3\u00a0months to 17\u00a0years old, were circumcised using the no\u2010flip ShangRing technique. All rings were removed 5\u20137\u00a0days later. Participants were evaluated weekly until the wound was completely healed. Data on procedure times, adverse events (AEs), time to clinical wound healing and satisfaction were recorded and analysed.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: Nearly all (79\/80, 98.8%) circumcisions were successfully completed using the no\u2010flip ShangRing technique without complications. In one (1.2%) case, the outer ring slipped off after the foreskin was removed and the procedure was completed by stitching. The mean circumcision and ring removal times were 7.4\u00a0\u00b1\u00a03.2 and 4.4\u00a0\u00b1\u00a04.2\u00a0min, respectively. There were four (5%) moderate AEs, which were managed conservatively. No severe AEs occurred. The mean time to complete clinical healing was 29.8\u00a0\u00b1\u00a07.3\u00a0days. Participants or their parents liked ShangRing circumcision because it improved hygiene, was quick and possessed an excellent cosmetic appearance. Most (72\/80, 94.7%) were very satisfied with the appearance of the circumcised penis, and all (100%) said they would recommend circumcision to others.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: Our results suggest that no\u2010flip ShangRing VMMC is safe and acceptable in boys below 18\u00a0years of age. Our results are to be compared those seen following ShangRing VMMC in African men. Further study with larger sample sizes are needed to explore the scalability of the ShangRing in larger paediatric cohorts in Africa. We believe that the ShangRing has great potential for use in all age groups from neonates to adults, which would simplify device implementation.<\/jats:p>","DOI":"10.7448\/ias.20.1.21588","type":"journal-article","created":{"date-parts":[[2017,7,10]],"date-time":"2017-07-10T23:29:16Z","timestamp":1499729356000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Use of the ShangRing circumcision device in boys below 18 years old in Kenya: results from a pilot study"],"prefix":"10.1002","volume":"20","author":[{"given":"Quentin D.","family":"Awori","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard K.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phillip S.","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jared N.","family":"Moguche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Ouma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betsy","family":"Sambai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Goldstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Barone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,7,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020298"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60312-2"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60313-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.aids.0000432444.30308.2d"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283504a3f"},{"key":"e_1_2_11_7_1","unstructured":"NASCOP. National guidance for VMMC in Kenya \u2013 2008 [Internet].2008[cited 2015 Feb 5]. Available from:http:\/\/malecircumcision.org\/programs\/documents\/KenyaMCguidance.pdf"},{"key":"e_1_2_11_8_1","unstructured":"UNAIDS. New data on male circumcision and HIV prevention: policy and programme implications [Internet]. [cited 2015 Feb 5]. Available from:http:\/\/data.unaids.org\/pub\/Report\/2007\/mc_recommendations_en.pdf"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001641"},{"key":"e_1_2_11_10_1","unstructured":"UNAIDS WHO. Joint strategic action framework to accelerate the scale\u2010up of voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa. 2011. Available from:http:\/\/www.who.int\/hiv\/pub\/strategic_action2012_2016\/en\/"},{"key":"e_1_2_11_11_1","unstructured":"WHO UNAIDS. A framework for voluntary medical male circumcision: VMMC 2021 [Internet].2016[cited 2016 Aug 24]. Available from:http:\/\/www.who.int\/hiv\/pub\/malecircumcision\/Policy_brief_VMCC_2021_web.pdf"},{"key":"e_1_2_11_12_1","unstructured":"NASCOP (Kenya). National voluntary medical male circumcision strategy 2014\/15\u20102018\/19 [Internet]. 2nd ed.2015[cited 2016 Aug 24]. Available from:https:\/\/www.malecircumcision.org\/sites\/default\/files\/document_library\/2ndNationalVMMCStrategy\u2010Kenya(2014\u20102019).pdf"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-12-20"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0002679"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000321"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3182968dda"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0000000000000061"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3182631d69"},{"key":"e_1_2_11_19_1","unstructured":"WHO prequalification of male circumcision devices PUBLIC report Product: PrePex Number : PQMC 0001\u2010001\u201000 Abstract Summary of prequalification status for PrePex.2013."},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31824ea1f2"},{"key":"e_1_2_11_21_1","unstructured":"KigoziG MusokeR KighomaNGR. The acceptability and safety of the ShangRing for adolescent male circumcision in Rakai Uganda. International AIDS Society Conference; 2014; Melbourne Australia. TUPE148 p."},{"issue":"1","key":"e_1_2_11_22_1","first-page":"113","article-title":"Clinical trials using the Shang Ring device for male circumcision in Africa: a review","volume":"3","author":"Barone MA","year":"2014","journal-title":"Transl Androl Urol."},{"issue":"3","key":"e_1_2_11_23_1","first-page":"250","article-title":"Circumcision with the Chinese ShangRing in children: outcomes of 824 cases","volume":"16","author":"Yan B","year":"2010","journal-title":"Natl J Andrology\u2010China."},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-2042.2012.03132.x"},{"issue":"12","key":"e_1_2_11_25_1","first-page":"1113","article-title":"No\u2010flip method versus external method for ShangRing circumcision: a meta\u2010analysis","volume":"20","author":"Cao D\u2010H","journal-title":"Natl J Andrology\u2010 China."},{"key":"e_1_2_11_26_1","unstructured":"ODK. Open data kit [Internet].2014[cited 2014 Nov 28]. Available from:https:\/\/opendatakit.org\/"},{"volume-title":"Adverse event action guide for male circumcision.","year":"2011","author":"Rech D","key":"e_1_2_11_27_1"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3182158967"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31827b2299"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(93)90163-J"},{"key":"e_1_2_11_31_1","doi-asserted-by":"crossref","unstructured":"TshimangaM HatzoldK MugurungiO MangwiroT NcubeG XabaS et al. Safety profile of Prepex male circumcision device and client satisfaction with adolescent males aged 13\u201317 years in Zimbabwe. Jaids. 2016 Jun 1;72:S36\u201342","DOI":"10.1097\/QAI.0000000000000799"},{"issue":"8","key":"e_1_2_11_32_1","first-page":"709","article-title":"Novel no\u2010flip Shang Ring circumcision for adult males: a clinical application study of 528 cases","volume":"20","author":"Yang B\u2010H","year":"2014","journal-title":"Natl J Andrology\u2010China."},{"issue":"3","key":"e_1_2_11_33_1","first-page":"250","article-title":"No flip ShangRing technique for adolescents","volume":"16","author":"Yan B","year":"2010","journal-title":"Natl J of Andrology."},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpurol.2011.02.013"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3468(05)80220-9"},{"issue":"1","key":"e_1_2_11_36_1","doi-asserted-by":"crossref","first-page":"e1000211","DOI":"10.1371\/journal.pmed.1000211","article-title":"Male circumcision at different ages in Rwanda: a cost\u2010effectiveness study","volume":"7","author":"Binagwaho A","journal-title":"PLoS Med."},{"key":"e_1_2_11_37_1","unstructured":"WHO JHPIEGO.Manual for early infant male circumcision under local anaesthesia.2010."},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-2290"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.7448%2FIAS.20.1.21588","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.7448\/IAS.20.1.21588","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T13:27:47Z","timestamp":1695562067000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.7448\/IAS.20.1.21588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,1]]}},"alternative-id":["10.7448\/IAS.20.1.21588"],"URL":"https:\/\/doi.org\/10.7448\/ias.20.1.21588","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"type":"print","value":"1758-2652"},{"type":"electronic","value":"1758-2652"}],"subject":[],"published":{"date-parts":[[2017,1]]},"assertion":[{"value":"2016-10-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-06-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-07-12","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"21588"}}