20th International AIDS Conference - Melbourne, Australia


MOPDC0104 - Poster Discussion Abstract

The effect of conditional economic compensation on uptake of voluntary medical male circumcision: a randomized controlled trial of a demand creation intervention for male circumcision in Kenya

Presented by Kawango Agot (Kenya).

H. Thirumurthy1, E. Evens2, S. Rao3, M. Lanham4, E. Omanga3, K. Agot3

1University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, United States, 2FHI 360, Durham, United States, 3Impact Research and Development Organization, Kisumu, Kenya, 4FHI 360, NC, United States

Background: Low uptake of voluntary medical male circumcision (VMMC) among high-risk men has been a major challenge to the scale-up of VMMC services in sub-Saharan Africa. While the barriers to male circumcision uptake are well understood, there is limited evidence on effective demand creation strategies for VMMC. We assessed whether conditional economic compensation can address reported economic barriers to VMMC uptake and increase circucmision coverage among older men in Nyanza Province, Kenya.
Methods: A total of 1,504 uncircumcised men aged 25-49 years were randomized to one of three intervention arms that were offered varying amounts of compensation if they came for VMMC within 2 months after randomization or to a control arm that was offered no compensation. Compensation took the form of food vouchers worth US$2.5, US$8, or US$15, which reflected a portion of transport costs and lost wages during the post-circumcision healing period of up to 3 days. Vouchers were valid at participating shops in the study region. The primary outcome was VMMC uptake within 2 months.
Results: VMMC uptake was significantly higher among participants randomized to receive compensation of US$8 (6.6%, 25/381) or US$15 (9.0%, 34/377) than among participants in the US$2 (1.9%, 7/376) or control arm (1.6%, 6/370). Logistic regression analysis showed that compared to participants in the control arm, those enrolled in the US$8 arm were significantly more likely to uptake VMMC (Adjusted odds ratio (AOR) 4.3; 95% CI 1.7-10.7) as were participants in the US$15 arm (AOR 6.0; 95% CI 2.6-15.2). The intervention was more effective in promoting VMMC uptake among men engaged in higher risk behaviors and among unmarried men. In-depth interviews confirmed that the intervention promoted circumcision by compensating for some of the costs associated with the procedure.
Conclusions: The provision of conditional economic compensation for VMMC was acceptable and feasible. Consistent with studies showing that incentives can increase utilization of health services, compensation with low-cost food vouchers was modestly effective in promoting VMMC uptake among men in a short time period. The effect of the intervention may be larger when promoted more intensively and implemented over a longer time period.

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