Background: Voluntary medical male circumcision (VMMC) programs have been implemented in fourteen countries in sub-Saharan Africa since 2007. The uptake of services has been suboptimal in some of these countries. Circumcision using device methods was postulated to increase the uptake of services. We conducted a systematic review to establish the uptake and acceptability of the PrePex and Shang Ring male circumcision devices in VMMC program countries.
Methods: A comprehensive literature search was carried out to identify studies reporting uptake or acceptability of either the PrePex or Shang Ring device methods. The search was limited to English language articles of studies among adolescents and adults in VMMC implementing countries. Two reviewers independently reviewed and abstracted data from each article. Uptake was defined as selection of a device, either the PrePex or Shang Ring, when offered a choice between the device and another method of circumcision. Uptake estimates were pooled in a meta-analysis and stratified by device method and participant age. Acceptability of device methods among recipients was summarized using four criteria and presented as proportions.
Results: Of the 391 total articles retrieved, 25 studies met the inclusion criteria. Of these, 7 articles reported uptake of device method. The pooled uptake estimate was 75% (95% CI 62% to 89%). Prepex uptake was estimated to be 73% while the Shang ring estimates were 82%. By age group, uptake of device methods among adolescents was 82% compared to 72% by adults. Majority (21) of the studies reported at least one criteria used to assess acceptability. Acceptability of the two device methods was high: 95% of participants reported satisfaction with a device procedure. The devices were not associated with lengthy periods from work. Almost all (97%) participants circumcised with the device methods indicated they would recommend a device procedure to a friend or relative.
Conclusions: Our findings showed a high uptake and acceptability of the two circumcision devices methods that have been prequalified by WHO for use among adolescents and adults. These findings support the likelihood that circumcision uptake could be assisted by introduction of the two device methods in countries where coverage remains suboptimal.