Abstract
Background:Seven new impact evaluations of pilot programs for increasing the demand for voluntary medical male circumcision (VMMC) provide evidence of what works and what does not. The study findings suggest that financial compensation designed to relieve the opportunity or transportation costs from undergoing the procedure can increase the uptake of VMMC. There is also evidence that programs using peer influence can be effective, although so far only sports-based programs demonstrate a strong effect. We explore the strength of evidence in each of these 7 studies to better interpret the findings for policy making.Methods:We perform a risk of bias assessment and conduct power calculations using actual values for each of the 7 studies.Results:Three of the 7 studies have a medium risk of bias, whereas the other 4 have a low risk of bias. All but 2 of the studies have adequate power to detect meaningful effects. In the 2 with insufficient power, the estimated effects are large but statistically insignificant.Conclusion:The positive evidence that financial incentives presented as compensation for opportunity costs to men seeking and obtaining VMMC can increase uptake comes from strong studies, which have high power and low to medium risk of bias. The positive evidence that a comprehensive sports-based program for young men can increase uptake also comes from a strong study. The strength of the studies further validates these findings.
Highlights
Since 2007, despite several initiatives to increase the prevalence of male circumcision in the 14 countries prioritized by the WHO and UNAIDS, the progress has been modest relative to the goal
The positive evidence that financial incentives presented as compensation for opportunity costs to men seeking and obtaining voluntary medical male circumcision (VMMC) can increase uptake comes from strong studies, which have high power and low to medium risk of bias
The positive evidence that a comprehensive sports-based program for young men can increase uptake comes from a strong study
Summary
Since 2007, despite several initiatives to increase the prevalence of male circumcision in the 14 countries prioritized by the WHO and UNAIDS, the progress has been modest relative to the goal. The goal was to circumcise 20 million men by 2015 to have a high epidemiologic impact,[1] as of the end of 2015, just over 10 million circumcisions were completed in the these countries.[2]. BCC can use a variety of channels, including mass media and community mobilization, to provide information on benefits from voluntary medical male circumcision (VMMC). BCC approaches alone are not enough to increase demand; a trial evaluating the impact of comprehensive information about male circumcision and HIV risk in Lilongwe, Malawi revealed that the information increased the likelihood of getting circumcised by only 1.4% points after 1 year.[5]. Seven new impact evaluations of pilot programs for increasing the demand for voluntary medical male circumcision (VMMC) provide evidence of what works and what does not. We explore the strength of evidence in each of these 7 studies to better interpret the findings for policy making
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