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Background: Voluntary Medical Male Circumcision (VMMC) reduces female to male HIV transmission by at least 60%. Although adult VMMC has been widely scaled up in most priority VMMC countries, Early Infant Male Circumcision (EIMC) has enjoyed little progress in just a few isolated places. Yet EIMC is easier and quicker to perform, the circumcision site heals faster, and it is more cost efficient compared to VMMC. In 2013, the Tanzanian Ministry of Health introduced EIMC as a pilot in Iringa Region, performed primarily by nurses, on the back of a well-established VMMC program. The safety of EIMC in this region is described.
Methods: We conducted a secondary review of the EIMC client level database from 2013-2015. Data were summarized in tables and appropriate frequencies calculated. Wilcoxon Rank Sum test was used to compare the mean age and body weight between infants with AEs and those without AEs, because the adverse event group had a very small sample size.
Results: A total of 3,308 infants were circumcised using the Mogen clamp between 2013 and 2015.3,123 (94%) clients returned for first follow-up. The intraoperative AE rate was 0.27% (9/3308) and post-operative AE rate 0.03% (1/3,213). Majority of the AEs were mild (6) or moderate (3) with only 1 severe AE. Intraoperative AEs reported included bleeding and excessive skin removal while the postoperative AE was insufficient skin removal. The severe AE was due to excessive skin removal which required surgical intervention by stitching.
There was no difference in intraoperative AE occurrence by age of the infant (p=0.982) or body weight at circumcision (p=0.613).
Conclusions: The AE rate in the EIMC pilot program in Iringa, Tanzania was low and similar to other programs in the region. Majority of the AEs occurred in the intra-operative period, contrary to the VMMC program where most AE are post-operative. Emphasis on the surgical skills may reduce the intraoperative AEs. EIMC scale-up is safe in rural resource-limited settings where nurses have taken the lead to provide this important and sustainable HIV prevention intervention.

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