Background: WHO and UNAIDS recommend voluntary medical male circumcision (VMMC) as a priority intervention in high HIV prevalence settings, such as Mozambique, for considerable reduction of sexual transmission of HIV. In Mozambique, VMMC has been provided as surgery since 2009. This requires certified providers and rigorous biosafety measures, making challenging the achievement of the MOH goal of 2 million males circumcised by 2017. PrePex?does not require injectable anesthesia or suturing circumcision. Using such devices could reduce staff needs, procedure time and costs, and increase the acceptability of VMMC. In 2013, a pilot study of the PrePex? device was started in Mozambique to assess the safety and acceptability of VMMC of this particular device among providers and clients.
Methods: At removal of the PrePexTM device, at day 7 post-placement, 111 clients were randomly asked for in-depth interviews about their experience, and whether they would recommend. The interview was repeated at the 28th day (control visit). Interview transcripts were entered, coded and scrutinized in ATLAS.Ti?, to identify issues with PrePex? not included in the client information package, and thus classified as “unusual”.
Results: In the interviews, 85.8% of the recipients of PrePexTM circumcision indicated they had a good experience with the device and 91.3% of the clients who used PrePexTM would recommend it to others. The interviews identified the occurrence of four presentations of discomfort not foreseen by the providers of device circumcision. The most frequent discomfort was the difficulty to keep the penis upright, followed by the tendency of the penis skin to adhere to underwear (complicating the act of urinating), quick soiling of the bandages before the scheduled visit, and need for frequent hygiene and cleansing due to odor when in bed. The complaints were associated with embarrassment in public (e.g., on a bus) and interference with social life.
Conclusions: Although satisfaction is high, unusual discomfort with PrePexTM may affect its acceptability. Therefore, appropriate measures should be considered when implementing large scale device circumcision, including information for clients on how to handle such situations need to be offered to device clients, and questionnaires to monitor the presence of forms of discomfort.

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