Prepex: makes sense and saved cents - JPS Africa
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Prepex: makes sense and saved cents

Medical male circumcision (MMC) has been shown to reduce the risk of female to male HIV infection and STIs by as much as 60%, as well as reducing the risks of prostate and cervical cancer. This is because it is associated with reduced penile human papillomavirus (HPV) which has been linked to cervical cancer. These benefits are long lasting. Once the circumcision takes place the patient will benefit from the prevention throughout his life. In addition, it could reduce the spread of HIV to women as well, as fewer men contract disease over time, so their female partners are better protected as well.

Research has shown that VMMC is not only effective in reducing HIV incidence but also reduces the financial costs of the HIV response. In a country with such a high number of HIV cases, this is an important fiscal decision. According to mathematical models, every dollar spent on VMMC has the potential to save $14 in care and treatment costs.

JPS Africa is working collaboratively with the Centre for Disease Control (CDC-SA) and the National Department of Health in assessing the uptake and subsequent roll-out of the WHO pre-qualified male circumcision device, PrePex. This device is a novel alternative to surgical circumcision and requires no injections, no suturing and is considered a bloodless procedure. It has shown favorable uptake and demand in areas where the device is widely available.

How does it work? PrePex is a non-surgical process of circumcision involving no cutting of live tissue. It involves the application of controlled radial elastic pressure to the foreskin between a rigid inner ring and an elastic ring, cutting off the blood flow to these tissues, and effectively letting the tissue die off. Though the procedure is not completely painless, men who use PrePex report less pain than men who undergo surgical circumcision. Beginning the process only takes five minutes, and is simple for both healthcare practitioners and their patients. In addition, men can return to work shortly after the procedure, reducing the time away from the office.

After 7 days, the necrotic foreskin and the device are removed by a healthcare practitioner. Although all medical procedures carry some risks, PrePex has been found to have lower risks of adverse effects such as bleeding, hematomas, and infection.

JPS Africa is leading the PrePex training across South Africa, assisting provinces with introducing this device at local facilities. PrePex allows a healthcare provider to reach between three and five times as many subjects as surgical circumcision, in the same amount time.

One of the major benefits of this procedure are that it can be administered by nurses – critically important in South Africa where nurses are more common than doctors, hence increasing the number of medical professionals that can execute the procedure and follow-up. This also incorporates VMMC into routine clinical services in SA, allowing for regular follow-ups and engagements of safe sexual health.

Many South African men will seek circumcision at some part of their lives as part of cultural initiation rites. Through collaboration with traditional leaders, PrePex and other VMMC services can be successfully incorporated into these rites of passage, with the benefit of reducing the risk of infection.