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

Caitlin E. Kennedy, Ping Teresa Yeh, Kaitlyn Atkins, Virginia A. Fonner, Michael D. Sweat, Kevin R. O'Reilly, George W. Rutherford, Rachel Baggaley, Julia Samuelson

Research output: Contribution to journalArticle

Abstract

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, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Meta-analysis of four RCTs showed significant impact of any economic compensation on VMMC uptake (relative risk: 5.23, 95% CI: 3.13 to 8.76). RCTs of food/transport vouchers and conditional cash transfers generally showed increases in VMMC uptake, but lotteries, subsidized VMMC, and receiving a gift appeared somewhat less effective. Three non-randomized trials showed mixed impact. Six additional studies suggested economic compensation interventions were generally acceptable, valued for addressing key barriers, and motivating to men. However, some participants felt they were insufficiently motivating or necessary; one study suggested they might raise community suspicions. One study from South Africa found a program cost of US$91 per additional circumcision and US$450-$1350 per HIV infection averted. CONCLUSIONS: Economic compensation interventions, particularly transport/food vouchers, positively impacted VMMC uptake among adult men and were generally acceptable to potential clients. Carefully selected economic interventions may be a useful targeted strategy to enhance VMMC coverage.

Original languageEnglish (US)
Pages (from-to)e0227623
JournalPloS one
Volume15
Issue number1
DOIs
StatePublished - Jan 1 2020

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Male Circumcision
systematic review
meta-analysis
Compensation and Redress
Meta-Analysis
Economics
HIV
economics
uptake mechanisms
food transport
Randomized Controlled Trials
South Africa
Costs and Cost Analysis
Costs
Coercion
Safe Sex
Zambia
Malawi
Food
Zimbabwe

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention : A systematic review and meta-analysis. / Kennedy, Caitlin E.; Yeh, Ping Teresa; Atkins, Kaitlyn; Fonner, Virginia A.; Sweat, Michael D.; O'Reilly, Kevin R.; Rutherford, George W.; Baggaley, Rachel; Samuelson, Julia.

In: PloS one, Vol. 15, No. 1, 01.01.2020, p. e0227623.

Research output: Contribution to journalArticle

Kennedy, Caitlin E. ; Yeh, Ping Teresa ; Atkins, Kaitlyn ; Fonner, Virginia A. ; Sweat, Michael D. ; O'Reilly, Kevin R. ; Rutherford, George W. ; Baggaley, Rachel ; Samuelson, Julia. / Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention : A systematic review and meta-analysis. In: PloS one. 2020 ; Vol. 15, No. 1. pp. e0227623.
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AU - Atkins, Kaitlyn

AU - Fonner, Virginia A.

AU - Sweat, Michael D.

AU - O'Reilly, Kevin R.

AU - Rutherford, George W.

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N2 - 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, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. Meta-analysis of four RCTs showed significant impact of any economic compensation on VMMC uptake (relative risk: 5.23, 95% CI: 3.13 to 8.76). RCTs of food/transport vouchers and conditional cash transfers generally showed increases in VMMC uptake, but lotteries, subsidized VMMC, and receiving a gift appeared somewhat less effective. Three non-randomized trials showed mixed impact. Six additional studies suggested economic compensation interventions were generally acceptable, valued for addressing key barriers, and motivating to men. However, some participants felt they were insufficiently motivating or necessary; one study suggested they might raise community suspicions. One study from South Africa found a program cost of US$91 per additional circumcision and US$450-$1350 per HIV infection averted. CONCLUSIONS: Economic compensation interventions, particularly transport/food vouchers, positively impacted VMMC uptake among adult men and were generally acceptable to potential clients. Carefully selected economic interventions may be a useful targeted strategy to enhance VMMC coverage.

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