As a spearhead in the global effort to eliminate HIV & AIDS, physician-scientists in Urology at Weill Cornell Medicine have been testing a device called the ShangRing that facilitates male circumcision for reduction in HIV transmission.
With funding from the Bill & Melinda Gates Foundation, Weill Cornell, and the NIH since 2007, Drs. Philip S. Li, Richard K. Lee, and Marc Goldstein of Weill Cornell Medicine, Department of Urology have been researching the effectiveness of the ShangRing for male circumcision. Previous studies published in The Lancet and New England Journal of Medicine have shown that male circumcision reduces the risk of HIV transmission by up to 60% as well as reducing HPV (human papilloma virus, the primary cause of cervical cancer) and HSV (herpes simplex virus) transmission. The group has now been awarded a new $4.2 million, 3.5 year grant from the Gates Foundation to lead a consortium to further study the ShangRing in Africa.
Addressing the new World Health Organization (WHO) strategic priority to further accelerate circumcision in sub-Saharan Africa, the grant builds on the group's previously groundbreaking work that demonstrate the safety and efficacy of ShangRing male circumcision in a series of randomized controlled trials across four countries. The procedure has been shown to be safe, effective, and more rapid than conventional circumcision (3 vs. 30 minutes). Importantly, it can be successfully and safely performed by clinical officers and nurses in addition to physicians. The group has recently successfully tested the use of a novel no-flip technique which further simplifies the technique as well as the use of topical anesthesia that increases the technique's appeal in both adolescents and adults. The new trial will now examine the use of ShangRing circumcision in infants, which holds the promise of being safer, technically simpler, and more cost-effective than adult circumcision. This work dovetails with the goal of 28.7 million circumcisions to be performed by 2025 in 14 priority sub-Saharan Africa countries as identified by the WHO and the Joint United Nations Program on HIV/AIDS (UNAIDS).
The ultimate goal of the research is to lay the groundwork for the "sustainability phase" as outlined in national male circumcision strategies and the WHO/UNAIDS Joint Strategic Framework. The activities will be carried out in close collaboration with local Ministries of Health and other partners and stakeholders, allowing for scale-up of appropriate interventions and enhancing sustainability. This project will contribute to the Gates Foundation's strategic goal of significantly reducing HIV transmission and will further spur circumcision efforts in WHO priority countries as well as support the development and introduction of male circumcision devices.