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A Randomized Evaluation of a Demand Creation Lottery for Voluntary Medical Male Circumcision Among Adults in Tanzania.

A Randomized Evaluation of a Demand Creation Lottery for Voluntary Medical Male Circumcision Among Adults in Tanzania.
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Bazant E, Mahler H, Machaku M, Lemwayi R, Kulindwa Y, Gisenge Lija J, Mpora B, Ochola D, Sarkar S, Williams E, Plotkin M, Juma J,


Bazant E, Mahler H, Machaku M, Lemwayi R, Kulindwa Y, Gisenge Lija J, Mpora B, Ochola D, Sarkar S, Williams E, Plotkin M, Juma J, (click to view)

Bazant E, Mahler H, Machaku M, Lemwayi R, Kulindwa Y, Gisenge Lija J, Mpora B, Ochola D, Sarkar S, Williams E, Plotkin M, Juma J,

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Journal of acquired immune deficiency syndromes (1999) 72 Suppl 4() S280-7 doi 10.1097/QAI.0000000000001042

Abstract
BACKGROUND
Uptake of voluntary medical male circumcision (VMMC) among adult men has fallen short of targets in Tanzania. We evaluated a smartphone raffle intervention designed to increase VMMC uptake in three regions.

METHODS
Among 7 matched pairs of health facilities, 1 in each pair was randomly assigned to the intervention, consisting of a weekly smartphone raffle for clients returning for follow-up and monthly raffle for peer promoters and providers. VMMC records of clients aged 20 and older were analyzed over three months, with the number performed compared with the same months in the previous year. In multivariable models, the intervention’s effect on number of VMMCs was adjusted for client factors and clustering. Focus groups with clients and peer promoters explored preferences for VMMC incentives.

RESULTS
VMMCs increased 47% and 8% in the intervention and control groups, respectively; however, the changes were not significantly different from one another. In the Iringa region subanalysis, VMMCs in the intervention group increased 336% (exponentiated coefficient of 3.36, 95% CI: 1.14 to 9.90; P = 0.028), after controlling for facility pair, percentage of clients ≥ age 30, and percentage testing HIV positive; the control group had a more modest 63% significant increase (exponentiated coefficient 1.63, 95% CI: 1.18 to 2.26; P = 0.003). The changes were not significantly different. Focus group respondents expressed mixed opinions about smartphone raffles; some favored smaller cash incentive or transportation reimbursement.

IMPLICATIONS
A smartphone raffle might increase VMMC uptake in some settings by helping late adopters move from intention to action; however, there is no recommendation for this intervention more generally.

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