Presentation Authors: Omar Al Hussein Alawamlh*, Richard K. Lee, Soo Jeong Kim, Ryan Flannigan, New York, NY, Quentin Awori, Nairobi, Kenya, Mark Barone, Marc Goldstein, Peter N. Schlegel, Philip S. Li, New York, NY
Introduction: Clinical trials in Africa have shown that voluntary medical male circumcision (VMMC) can reduce HIV transmission by up to 60%. Part of the barrier to the scale up of VMMC services in Africa is the lack of well-trained healthcare (HC) providers to perform the procedure. Device-assisted MC has thus been proposed to simplify the procedure and enhance its acceptability. Therefore, we created a mobile/tablet application (app) for the ShangRing (SR), a WHO pre-qualified male circumcision (MC) device, to serve as a reference and a learning platform for HC providers following proper hands-on training.
Methods: Urologists and researchers from Weill Cornell Medical College and Population Council compiled all contents of the app that were gathered from: the SR instructions guide, the WHO instruction for use document, and clinical trials previously conducted by our group. Utilizing these contents, the app was designed, coded, and structured.
Results: Currently available on the App Store and Google Play Store, the app features the following sections:_x000D_
1- Fundamentals: Contains all necessary information in step-by-step fashion to prepare for and perform the procedure. This section describes both techniques of SR MC, the flip and no-flip methods, in addition to how to use either topical or injectable anesthesia for the procedure. Various visual aids including offline videos, live pictures and illustrations are embedded within the section.2- Common mistakes: Information regarding the mistakes which may be encountered and how to prevent them with instructive images and videos.3- Normal wound healing: Shows pictures, which depict the course of healing at different time intervals. This section describes what to expect following the procedure in terms of gross tissue features.4- Prevention and management: Discusses the different adverse events that may be encountered during the postoperative period and how to manage them. Pictures are provided for the adverse events.5- Postoperative instructions for patients: Comprises all the instructions which the HC provider must present to the patient in the postoperative period, including device removal that can be either planned or spontaneous.6- Two calculators: For device size calculation and calculation of the safest maximum dose of injectable anesthetic to be used.
Conclusions: The SR surgical training app is the first of its kind. It is a simple and user-friendly tool which can significantly aid HC providers in various ways when planning to learn and perform SR MC specifically in resource-poor settings.