This report presents the background information and proceedings of the January 2013 meeting of the World Health Organization (WHO) Technical Advisory Group (TAG) on Innovations in Male Circumcision. The meeting focused on reviewing the clinical performance of two devices for adult male circumcision, ShangRing and PrePex. Data were insufficient to review other devices. In accordance with the WHO Framework for Clinical Evaluation of Male Circumcision Devices, staff compiled clinical data by reviewing all published information and contacting researchers evaluating the devices. Data were extracted into standardized formats and reviewed by the TAG for clarification and classification of adverse events, and across priority standardized outcomes: patient eligibility; successful circumcision; procedure time; time to complete wound healing; pain; and acceptability. The report includes summaries of the data used and key points raised by the TAG for each device. The meeting discussions also informed programmatic considerations included in WHO guidance and identified key information gaps and research needs.

This comprehensive manual describes the safest and most practical methods for male circumcision (MC) in resource-limited settings. It starts by describing the benefits and risks of MC, and how MC can be linked to other sexual and reproductive health services. The bulk of the manual provides technical guidance on the MC procedure, detailing the knowledge, skills, and attitudes providers need to safely carry out different procedures. Containing multiple photos and drawings, sample consent forms, information sheets for clients, stock cards, adverse event forms, the manual is an excellent training tool. It also contains chapters on counseling clients, obtaining informed consent for MC, preventing infection, managing complications, and running an MC service.

A situation analysis is crucial to developing safe male circumcision (MC) services. Such an analysis can help program planners understand the determinants and scale of MC practices; assess current capacity to perform safe MC; and determine whether community support exists for MC. This toolkit contains six tools that can be used to obtain a situation analysis from which to build a successful MC program. These tools provide guidance on desk reviews, key informant interviews, stakeholders’ meetings, focus groups, assessments of service availability, feedback, and action.

Indicators are needed to measure the degree to which an intervention or program is achieving its goals. This guide includes indicators related to creating demand for male circumcision (MC), generating supply for MC, and maximizing safer sexual behavior. When used, these indicators can help provide feedback for managing MC programs. Targeted indicators for indicators for advocacy include a strong policy component, and behavior/social change. Each indicator is described in detail, including what the indicator is intended to measure, recommended frequency of reporting, measurement tools needed, how the data will be collected, numerators, denominators, and how to interpret the indicator. Countries can choose to add specific indicators to their programs, or adapt them for use.

This workbook is intended for use by health care providers who are being trained to perform male circumcision (MC) under local anesthesia. The innovative, flexible, competency-based course builds on an individualized assessment of knowledge and skills. The self-paced, individualized learning workbook is designed to be completed at the home facility over two to four weeks, and used in conjunction with classroom demonstration and coaching using anatomic models, simulation exercises, and clinic attachment. The course is meant to be flexible and adaptable while maintaining the standards of more formal training. It allows participants to move at their own pace, and enables both participants and trainers to spend less time away from their clinical duties, with less service disruption. The course is designed to build providers' capacity to provide MC-related services including describing the relationship of MC and HIV; linking with other male sexual and reproductive health services; counseling and screening adult and adolescent clients; building competency in one of the surgical methods of MC'; providing post-operative care, including managing adverse events; preventing infection; and monitoring, evaluating, and supervising a male circumcision service.