Increasing voluntary medical male circumcision uptake among adult men in Tanzania

Abstract

Objective:We evaluated a demand-creation intervention to increase voluntary medical male circumcision (VMMC) uptake among men aged 20–34 years in Tanzania, to maximise short-term impact on HIV incidence.Methods:A cluster randomized controlled trial stratified by region was conducted in 20 outreach sites in Njombe and Tabora regions. The sites were randomized 1 : 1 to receive either a demand-creation intervention package in addition to standard VMMC outreach, or standard VMMC outreach alone. The intervention package included enhanced public address messages, peer promotion by recently circumcised men, facility setup to increase privacy, and engagement of female partners in demand creation. The primary outcome was the proportion of VMMC clients aged 20–34 years.Findings:Overall, 6251 and 3968 VMMC clients were enrolled in intervention and control clusters, respectively. The proportion of clients aged 20–34 years was slightly greater in the intervention than control arm [17.7 vs. 13.0%; prevalence ratio = 1.36; 95% confidence intervals (CI):0.9–2.0]. In Njombe region, the proportion of clients aged 20–34 years was similar between arms but a significant two-fold difference was seen in Tabora region (P value for effect modification = 0.006). The mean number of men aged 20–34 years (mean difference per cluster = 97; 95% CI:40–154), and of all ages (mean difference per cluster = 227, 95% CI:33–420) were greater in the intervention than control arm.Conclusion:The intervention was associated with a significant increase in the proportion of clients aged 20–34 years in Tabora but not in Njombe. The intervention may be sensitive to regional factors in VMMC programme scale-up, including saturation.

Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less

“…Data on the number, client age, and location of VMMCs performed were obtained from the trial data set. 34 Trial results showed that the total number of VMMC clients of all ages was higher in the intervention arms than in the control arms: 6251 vs. 3968, respectively (RR 1.4). Although the total number and proportion of clients aged 20–34 years were greater in the intervention arms, there was a non-significant difference in the proportion of men aged 20–34 years between intervention and control arms (11.3% vs. 14.7%, respectively) in Njombe, whereas a two-fold statistically-significant difference was observed in Tabora (27.5% vs. 11.5%).…”

“…Details of the trial design and outcomes have been published. 34 The trial aimed to assess VMMC uptake among men aged 20–34 years following the locally-tailored demand creation strategy described compared with the standard of care normally delivered. Ten clusters were randomly selected per region and evenly allocated across control and intervention arms.…”

“…This study seeks to bridge that gap in the literature by analyzing the cost and cost-effectiveness of a targeted demand creation intervention in the context of a randomized controlled trial in Tanzania evaluating VMMC uptake among men aged 20–34 years in 2 settings with different HIV-prevalence rates. 34 …”

Geospatial assessment of the voluntary medical male circumcision programme in Tanzania, 2011–2016

“…These older males usually perceive themselves as low-risk individuals for HIV infection and thus are relatively less receptive to VMMC 4. The estimated low MC incidence in males aged 20–24 years can be associated with previous findings in which most VMMC clients in Tanzania were younger males, with about 76% of VMMC performed for males under 20 years of age in 2014 23 24…”

Scale-Up of Voluntary Medical Male Circumcision Services for HIV Prevention — 12 Countries in Southern and Eastern Africa, 2013–2016

“…Multiple countries increased the proportion of males aged 15–29 years who were provided VMMC in 2016, when PEPFAR began emphasizing prioritizing VMMC in this age group to most immediately achieve the HIV preventive benefit of VMMC ( 8 ); however, the overall percentage of males aged 15–29 years who were circumcised declined in 2016. CDC continues to work with partners to identify and implement innovative approaches to increase VMMC demand among these men ( 9 ). The large proportion of VMMC clients aged <15 years also likely accounts for the lower HIV prevalence observed among VMMC clients compared with national estimates, ** because many of those aged <15 years likely had not yet had sexual intercourse, the primary mode of HIV transmission in this setting.…”