Knowledge, attitude and practices on shangring method of male circumcision in preventing new HIV infections among Community members in Homa Bay county, Kenya

Abstract

Despite robust evidence that voluntary medical male circumcision reduces heterosexual HIV transmission risk by approximately 60%, uptake of the ShangRing device a bloodless, faster, and highly acceptable alternative to conventional surgical circumcision remains persistently low (2-5% of VMMC procedures) in Homa Bay County, Kenya. This county continues to bear a high HIV burden, with an adult prevalence of approximately 11.41% and 1,180 new infections reported in 2024. The main objective of this study was to determine the knowledge, attitudes, and practices regarding the ShangRing method of male circumcision in preventing new HIV infections among community members in Homa Bay County. Specifically, the study sought to establish the level of knowledge about ShangRing as a method of voluntary medical male circumcision, describe attitudes towards the ShangRing method, and establish practices related to its use. A cross-sectional mixed-methods design was employed. Quantitative data were collected using a structured questionnaire administered to 422 men aged 15-49 years selected through simple random sampling from attendees at four purposively selected health facilities offering ShangRing services. Qualitative data were collected through key informant interviews and focus group discussions. Quantitative data were analyzed using descriptive statistics, chi-square tests, Pearson correlation, and multiple linear regression in SPSS version 29.0, while qualitative data underwent thematic analysis. Results showed moderate knowledge (mean composite score 15.76/25; 58.3% sufficient), moderately positive attitudes (mean score 17.21/30), and moderately good practices (mean score 16.94/25), with 86.5% of respondents willing to undergo or recommend the ShangRing method. Knowledge (β = 0.290, p < 0.001) and attitudes (β = 0.128, p = 0.022) were significant predictors of favourable practices (R² = 0.073, p < 0.001). Important knowledge gaps and misconceptions, particularly regarding partner protection and risk compensation, persisted. The study concludes that while community members demonstrate positive attitudes and high individual acceptability of ShangRing, knowledge gaps and cultural barriers hinder optimal uptake. Strengthening community awareness, addressing misconceptions, and implementing targeted demand-creation strategies may enhance adoption of ShangRing and contribute to HIV prevention in high-burden settings. These findings provide evidence to inform policy and programmatic interventions aimed at increasing ShangRing uptake as part of Kenya‘s comprehensive HIV prevention strategy