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Background: Early Infant Male Circumcision (EIMC) is a key component of combination HIV prevention in high HIV burden countries. However, provision of EIMC is limited due to lack of qualified providers and concerns about potential complications. Adequate competence-based training of non-physician personnel using a structured curriculum can avoid complications and enhance scale-up of EIMC in regions with low physician coverage.
Methods: Didactic and practicum training in the provision of EIMC using the Mogen clamp uder topical anesthesia was conducted for 10 Clinical officers (COs) and 10 Registered Nurse Midwives (RNMWs) in preparation for a trial on safety and acceptability of EIMC in Rakai, Uganda. Neonates whose mothers provided written consent were assigned in tandem to the 20 trainees. Each trainee performed at least 10 circumcision procedures. Ongoing assessment of competency was based trainer feedback provided immediately after surgery.
Results: A total of 202 babies were circumcised by trainees but only100 (5 per trainee) were used for the assessment of trainee''s competence i.e. Procedures 1, 3, 5, 7, and 9.
In a pretest of competency, 20% of COs and 10% of NMWs scored above the pass mark (set at 80%). By 7th EIMC procedure , all trainees had achieved pass mark competency. The variability in performance scores significantly declined with increasing number of procedures performed.The median time per was similar between COs (13 minutes) and NMW s (12 minutes). Safety of EIMC was comparable between COs and NMWs. Four moderate insufficient skin removals occured; 2 by CO s and 2 by NMWs.
Conclusions: Training of non-physicians improved knowledge and competency in EIMC and the gain in competency was similar among COs and NMWs using the same training program.

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