Systematic review of the effect of economic compensation and incentives on uptake of voluntary medical male circumcision among men in sub-Saharan Africa

Abstract

Voluntary medical male circumcision (VMMC) prevalence in priority countries in sub-Saharan Africa, particularly among men aged ≥20 years, has not yet reached the goal of 80% coverage recommended by the World Health Organization. Determining novel strategies to increase VMMC uptake among men ≥20 years is critical to reach HIV epidemic control. We conducted a systematic review to analyze the effectiveness of economic compensation and incentives to increase VMMC uptake among older men in order to inform VMMC demand creation programs. The review included five qualitative, quantitative, and mixed methods studies published in peer reviewed journals. Data was extracted into a study summary table, and tables synthesizing study characteristics and results. Results indicate that cash reimbursements for transportation and food vouchers of small nominal amounts to partially compensate for wage loss were effective, while enrollment into lotteries offering prizes were not. Economic compensation provided a final push toward VMMC uptake for men who had already been considering undergoing circumcision. This was in settings with high circumcision prevalence brought by various VMMC demand creation strategies. Lottery prizes offered in the studies did not appear to help overcome barriers to access VMMC and qualitative evidence suggests this may partially explain why they were not effective. Economic compensation may help to increase VMMC uptake in priority countries with high circumcision prevalence when it addresses barriers to uptake. Ethical considerations, sustainability, and possible externalities should be carefully analyzed in countries considering economic compensation as an additional strategy to increase VMMC uptake.

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

“…This review adds to the growing body of evidence of the effectiveness of financial compensation at increasing VMMC uptake . We found that higher compensation was associated with larger effect size; however, the observed absolute difference in uptake was small .…”

“…It is important that the value of financial incentives in future programmes is optimized to maximize cost-effectiveness. Carrasco et al argue that it may be most cost-effective to introduce financial incentives in settings with an already high prevalence of VMMC to focus on men who would not have "accessed the services otherwise" [24].…”

“…The mixed methods approach builds on the work by Carrasco et al . and enhances understanding of contextual factors important to the interventions which should prove useful for policy makers .…”

“…Carrasco et al . argue that it may be most cost‐effective to introduce financial incentives in settings with an already high prevalence of VMMC to focus on men who would not have “accessed the services otherwise” .…”

“…This review extends the work of Tamuzi et al as demand creation interventions of all types were assessed allowing comparisons between and within intervention types [23]. The mixed methods approach builds on the work by Carrasco et al and enhances understanding of contextual factors important to the interventions which should prove useful for policy makers [24].…”