Bibliographic Info
GuidelineConsolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach
Year of Publication2021
Issuing InstitutionWHO
Recommendation
Status
Maintained
Recommended in favor
Conditional
Certainty of evidence
Low
WHO prequalified male circumcision devices may be used as additional methods of male circumcision in the context of HIV prevention and in keeping with decisions whether to offer VMMC to adolescents ages 10 through 14 years.
Notes and Remarks
- 1)These recommendations apply in settings where: a) the devices are used by health care workers, including physicians and midlevel clinicians, who are appropriately trained and competent in the use of the specific device; and b) surgical backup facilities and skills are available as appropriate to the specific device.
- 2)The recommendations were considered conditional because: a)evidence on use at a large scale is limited b) evidence on use with a large number of adolescents is limited.
- 3)• Each circumcision device is unique. WHO prequalification is provided only for specific device products.
- 4)Differences in eligibility exist among device types and with conventional surgical methods. A small proportion of adult men are not eligible for device-based methods; for younger adolescents a large proportion are not eligible.
- 5)When device-based procedures are performed by appropriately trained health care workers, their safety (based on rates of mild, moderate and severe has been similar to that of conventional surgery. However, the elastic collar compression device type has been associated with tetanus, which is rare but has a high case fatality rate. Tetanus is preventable, but offering 2 doses of TTCV prior to VMMC resulted in low VMMC uptake.
- 6)Healing times after in situ type device-based procedures are one to two weeks longer than after surgical circumcision since healing is by secondary intention. For surgical assist methods, healing may be shorter or similar to that for conventional surgery.
- 7)Device-based methods may have some benefits over surgical VMMC, although these advantages are not yet clearly established: a)Procedure time is shorter; however, a second visit is required for device removal. b)Most men and adolescent boys consider device-based methods acceptable. These methods may reduce loss of work or school time, and they provided a more regular cosmetic result. c) Health care providers find device options simpler and easier to use.
- 8)Costs of device-based methods are similar to those of surgical methods. Scale-up may yield efficiencies.
- 9)Implementation and scale-up require post-market surveillance
Also Featured In
This recommendation also appears in the following guidelines:
Originally Developed
Guideline
Preventing HIV through safe voluntary medical male circumcision for adolescent boys and men in generalized HIV epidemics: recommendations and key considerations: web annex 2.3 part 2. synthesis of literature on voluntary medical male circumcision: facilitators and barriers, by country
Year2020
InstitutionWorld Health Organization