Background: The safety and efficacy of the PrePexTM device for voluntary medical male circumcision (VMMC) has been demonstrated in studies in sub-Saharan Africa, leading to the conditional prequalification of the device for use in adults. WHO has recommended that use of the device could extend to eligible 13-17 year-olds, but only under active surveillance. We present preliminary findings from active surveillance of the device among adolescents in Zimbabwe.
Methods: Between October 2015 and January 2016, PrePex circumcisions were conducted at three VMMC clinics. Adolescents circumcised using PrePex during routine service delivery were actively followed up. Outcome measures for the active surveillance included percentage of i) adolescent men seeking VMMC who chose PrePex over the surgical procedure, ii) PrePex clients failing to return to the clinic for scheduled visits on days 7, 14 and 49, iii) PrePex clients returning to the clinic for each scheduled visit after receiving reminders and iv) adverse events (AEs).
Results: A total of 562 men (ages 13-17) were circumcised across the three active surveillance sites. Of these, 256 (45.5%) opted for PrePex but only 168 were eligible. The 88/256 (34.4%) that were ineligible were surgically circumcised. Reasons for ineligibility included: adhesions/tight foreskin/frenulum (n=58, 65.9%), mostly in 13 (n=40/58, 69%) and 14 year olds (n=10/58, 17.2%); presence of sexually transmitted infections (n=2, 2.3%); urinary tract infection (n=1, 1.1%). In 27 adolescents (30.7%), the available PrePex device sizes were too large mostly in boys aged 13 (n=18, 66.7%) and 14 years (n=8, 29.6%). 161/168 (95.8%) of the PrePex clients returned for the scheduled removal visit on day 7, six (85.7%) reported on day 8 and 1 (14.3%) on day 10. AEs included one moderate AE due to pain requiring early removal and 2/168 with mild edema.
Conclusions: These preliminary results suggest that the device is both safe and acceptable when used with adolescents 13-17 years in routine service delivery. Significant preference of surgical circumcision and high medical ineligibility suggest that both VMMC methods need to complement each other in programs targeting adolescent men. Smaller device sizes need to be available especially for the younger adolescents (13-14 years).

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