Process Evaluation of a Sport-Based Voluntary Medical Male Circumcision Demand-Creation Intervention in Bulawayo, Zimbabwe

DeCelles, Jeff; Hershow, Rebecca B.; Kaufman, Zachary A.; Gannett, Katherine; Kombandeya, Thandanani; Chaibva, Cynthia; Ross, David A.; Harrison, Abigail

doi:10.1097/qai.0000000000001172

Cited by 15 publications

(17 citation statements)

References 14 publications

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“…Participants in interviews and focus groups included men who were and were not circumcised, their female partners, and key informants involved in implementation. The details of each study including key findings are summarized in Table 3 [13][14][15]18,30,36].…”

Section: Qualitative Resultsmentioning

confidence: 99%

“…The 18 papers included were published between 2014 and 2018 and presented data associated with 16 studies; five cluster randomised control trials (CRCTs) [13,14,16,[28][29][30], six RCTs [17,19,20,[31][32][33], two prospective interventional cohorts [34,35], two quasi-experimental [18,36] and one "non-experimental" study (amended from an RCT due to delays with VMMC service implementation) [21] (Table 1). Studies took place across seven countries in SSA.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…In 2016, an eleven-paper series assessed the effectiveness of seven different VMMC demand creation programmes in SSA. Sgaier et al reviewed the impact evaluations from five randomized controlled trials (RCTs) and two quasi-experimental studies [13][14][15][16][17][18][19][20][21][22]. Three interventions, two offering financial incentives [19,20] and one novel football-based education sessions [16], reported significant impact, while qualitative components from others gave good insight into their implementational shortcomings [7].…”

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confidence: 99%

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The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

et al. 2019

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Introduction UNAID S has recommended that in 14 countries across sub‐Saharan Africa ( SSA ), 90% of men aged 10 to 29 years should be circumcised by 2021 to help reduce transmission of HIV . To achieve this target demand creation programmes have been widely implemented to increase demand for Voluntary Medical Male Circumcision ( VMMC ). This review explores the effectiveness of demand creation interventions and factors affecting programme implementation. Methods We completed a mixed methods systematic review searching Medline, Embase, Global health, psyc INFO and CINAHL databases in August 2018 with no time restrictions. Demand creation interventions conducted in SSA were categorized and quantitative data about VMMC uptake was used to compare relative and absolute effectiveness of interventions. Qualitative data were summarized into themes relevant to the delivery and impact of programmes. Results and discussion Eighteen of the 904 titles were included in the review. Effective interventions were identified in each demand creation category: financial incentives, counselling or education, involvement of influencers and novel information delivery. Of the 11 randomized controlled trials ( RCT s), the greatest absolute impact on VMMC prevalence was seen with a complex intervention including VMMC promotion training for religious leaders (compared to control: 23% (95% CI 22.8 to 23.8) absolute increase; odds ratio ( OR ) 3.2 (1.4 to 7.3)). Financial incentives generally produced the largest relative effects with men up to seven‐times more likely to undergo VMMC in the intervention arm compared to control (adjusted OR 7.1 (95% CI 2.4 to 20.8), 7.1% (3.7 to 10.5) absolute increase). Qualitative findings suggest that interventions are more impactful when they are judged appropriate and acceptable by the target population; delivered by people with relevant personal experience; and addressing broader social and cultural influences through partnership with and education of community leaders. Conclusions A range of demand creation interventions can increase VMMC uptake. The most acceptable and effective interventions are financial incentives framed as fair compensation (relative effect) and programmes of education or counselling delivered by people who are influential in the community (absolute effect). Future research should include larger studies with longer follow‐up and a consistent definition of VMMC uptake.

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Section: Qualitative Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

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confidence: 99%

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The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

et al. 2019

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“…Acceptability. We identified six studies that examined acceptability of economic compensation intervention: four qualitative studies and two quantitative surveys (Table 2) [24,31,[33][34][35][36]. These studies suggested incentives are generally acceptable, valued for addressing key barriers, and motivating to men.…”

Section: Effectiveness Reviewmentioning

confidence: 99%

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis

et al. 2020

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Background Economic compensation interventions may help support higher voluntary medical male circumcision (VMMC) coverage in priority sub-Saharan African countries. To inform World Health Organization guidelines, we conducted a systematic review of economic compensation interventions to increase VMMC uptake. Methods Economic compensation interventions were defined as providing money or in-kind compensation, reimbursement for associated costs (e.g. travel, lost wages), or lottery entry. We searched five electronic databases and four scientific conferences for studies examining the impact of such interventions on VMMC uptake, HIV testing and safer-sex/risk-reduction counseling uptake within VMMC, community expectations about compensation, and potential coercion. We screened citations, extracted data, and assessed risk of bias in duplicate. We conducted random-effects meta-analysis. We also reviewed studies examining acceptability, values/preferences, costs, and feasibility. Results Of 2484 citations identified, five randomized controlled trials (RCTs) and three non-randomized controlled trials met our eligibility criteria. Studies took place in Kenya,

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“…Accompanying qualitative studies found that participants reported the fear of pain associated with VMMC as being one of the main reasons individuals did not take up VMMC despite the financial incentive. A recent study [12] found that counselling through "role models"circumcised young men in a football-focussed interventionresulted in a 7.6% increase in VMMC uptake amongst 14-to 20-yearold males. This study highlights the role of social learning in enhancing "self-efficacy" [13] for VMMC and explores the possible combination of social learning and behavioural incentives.…”

Section: Introductionmentioning

confidence: 99%

Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, East Zimbabwe: study protocol for a pilot randomised trial

Thomas

Skovdal

Galizzi

et al. 2020

Trials

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Background: Voluntary medical male circumcision (VMMC) is a key component of combination HIV-prevention programmes. Several high-HIV-prevalence countries in sub-Saharan Africa, including Zimbabwe, are looking to scale up VMMC activities. There is limited evidence on how a combination of social learning from peer education by a role model with different behavioural incentives influences demand for VMMC in such settings. Methods/Design: This matched-cluster randomised controlled trial with 1740 participants will compare two behavioural incentives against a control with no intervention. In the intervention clusters, participants will participate in an education session delivered by a circumcised young male ("role model") on the risks of HIV infection and the benefits from medical male circumcision. All participants will receive contributions towards transport costs to access medical male circumcision at participating clinics. Via blocked randomisation, in the intervention clusters participants will be randomly assigned to receive one of two types of incentivesfixed cash payment or lottery paymentboth conditional on undergoing surgical VMMC. In two sites, a community-led intervention will also be implemented to address social obstacles and to increase support from peers, families and social structures. Baseline measures of endpoints will be gathered in surveys. Follow-up assessment at 6 months will include self-reported uptake of VMMC triangulated with clinic data. Discussion: This is the first trial to pilot-test social learning to improve risk perception and self-efficacy and to address the fear of pain associated with VMMC and possible present-biased preferences with front-loaded compensations as well as fixed or lottery-based cash payments. This study will generate important knowledge to inform HIV-prevention policies about the effectiveness of behavioural interventions and incentives, which could be easily scaled-up. Trial registration: This trial has been registered on ClinicalTrials.gov (identifier: NCT03565588). Registered on 21 June 2018.

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Process Evaluation of a Sport-Based Voluntary Medical Male Circumcision Demand-Creation Intervention in Bulawayo, Zimbabwe

Cited by 15 publications

References 14 publications

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis

Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, East Zimbabwe: study protocol for a pilot randomised trial

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