Abstract
The Ugandan government is committed to scaling-up proven HIV prevention strategies including safe male circumcision, and innovative strategies are needed to increase circumcision uptake. The aim of this study was to assess the acceptability and feasibility of implementing a soccer-based intervention (“Make The Cut”) among schoolboys in a peri-urban district of Uganda. The intervention was led by trained, recently circumcised “coaches” who facilitated a 60-minute session delivered in schools, including an interactive penalty shoot-out game using metaphors for HIV prevention, sharing of the coaches’ circumcision story, group discussion and ongoing engagement from the coach to facilitate linkage to male circumcision. The study took place in four secondary schools in Entebbe sub-district, Uganda. Acceptability of safe male circumcision was assessed through a cross-sectional quantitative survey. The feasibility of implementing the intervention was assessed by piloting the intervention in one school, modifying it, and implementing the modified version in a second school. Perceptions of the intervention were assessed with in-depth interviews with participants. Of the 210 boys in the cross-sectional survey, 59% reported being circumcised. Findings showed high levels of knowledge and generally favourable perceptions of circumcision. The initial implementation of Make The Cut resulted in 6/58 uncircumcised boys (10.3%) becoming circumcised. Changes made included increasing engagement with parents and improved liaison with schools regarding the timing of the intervention. Following this, uptake improved to 18/69 (26.1%) in the second school. In-depth interviews highlighted the important role of family and peer support and the coach in facilitating the decision to circumcise. This study showed that the modified Make The Cut intervention may be effective to increase uptake of safe male circumcision in this population. However, the intervention is time-intensive, and further work is needed to assess the cost-effectiveness of the intervention conducted at scale.
Highlights
The annual number of people newly infected with HIV has remained stable in the last few years, with an estimated 1.9 million new infections globally in 2015 [1]
In 2012, Grassroot Soccer (GRS), a sport-based HIV prevention organization initiated in Zimbabwe, developed a single-session voluntary medical male circumcision (VMMC) demand-creation intervention called Make The Cut in which trained, recently circumcised “coaches” facilitate a 60-minute educational session with male adolescent students
To reach the target of 80% coverage, there is a need for demand-creation interventions that provide motivation to males who have not yet chosen to undergo circumcision despite widespread media campaigns, demand-creation initiatives, and social pressure
Summary
The annual number of people newly infected with HIV has remained stable in the last few years, with an estimated 1.9 million new infections globally in 2015 [1]. Uganda is one of 14 VMMC priority countries in Sub-Saharan Africa, due to high HIV incidence and low circumcision prevalence, and an estimated 2.7 million VMMCs were performed between 2008 and 2015 [4]. The greatest impact of VMMC on HIV incidence over a 15-year period will result from focusing on uptake among boys and men aged 10–19 years [8]. To increase VMMC uptake among young men, demand-creation interventions have included activities in schools and sport-based activities [9, 10]. In 2012, Grassroot Soccer (GRS), a sport-based HIV prevention organization initiated in Zimbabwe, developed a single-session VMMC demand-creation intervention called Make The Cut in which trained, recently circumcised “coaches” facilitate a 60-minute educational session with male adolescent students.
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