Cohort study of the implementation of a Unicirc circumcision training program in KwaZulu-Natal, South Africa

Background Voluntary medical male circumcision (VMMC) is a key intervention to prevent HIV transmission, but open surgical circumcision requires extensive training and lacks the capacity for further upscaling. The objective of this study was to evaluate the results of a simplified device-based circumcision training program among primary care doctors, nurses, and clinical associates. Methods This was a prospective cohort study of a training program in KwaZulu-Natal, South Africa, which evaluated the training of primary care doctors and mid-level providers, and subsequent surgical outcomes. Results A total of 67 providers were successfully trained in the Unicirc method, among which 37 (55%) were nurses and clinical associates. A total of 1,240 men and boys were circumcised with a low rate (2.4%) of mild or moderate adverse events. There were no serious adverse events. Conclusions Instrument-based circumcision with Unicirc simplifies the procedure to make it amenable to training of mid-level providers in rural settings with a low rate of adverse events. Widespread adoption of this method may result in improved access to safe circumcision services for men and boys.