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Background: Medical male circumcision (MMC) for HIV prevention is a priority in 14 East and Southern African countries, and the long-term sustainability of MMC programs could best be achieved by offering early infant male circumcision (EIMC.) However, the acceptability and safety of EIMC provided by non-physicians is unknown.
Methods: We conducted a trial of EIMC provided by newly trained clinical officers (CO) and registered nurse midwives (RNMWs) newly trained in using the Mogen clamp and topical anesthesia in 4 health centers in rural Rakai, Uganda. Mothers were invited to participate in the trial and 501 healthy neonates aged 1-28 days with normal birth weight and gestational age were randomized to CO (n=256) and RNMWs (n=245), and were followed at 24 hours, 7 and 28 days.
Results: Of the 701 mothers invited to participate in the trial, 525 consented to circumcision (74.9%) and 24 were found ineligible on screening (4.4%). The procedure took an average of 10.5 minutes. Follow up was over 90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% with CO and 1.6% with RNMW surgeries (p=0.9). All wounds were healed by 4 weeks post-circumcision.
Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs.
Conclusions: Early infant male circumcision was acceptable in this rural Ugandan population, and can be safely performed by registered nurse midwives who have direct contact with mothers during pregnancy and delivery. EIMC services should be made available to parents who are interested in the service.

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