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

Author

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  • 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

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.

Suggested Citation

  • 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, 2020. "Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis," PLOS ONE, Public Library of Science, vol. 15(1), pages 1-15, January.
    • Handle: RePEc:plo:pone00:0227623
    DOI: 10.1371/journal.pone.0227623
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    References listed on IDEAS

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    1. Jobiba Chinkhumba & Susan Godlonton & Rebecca Thornton, 2014. "The Demand for Medical Male Circumcision," American Economic Journal: Applied Economics, American Economic Association, vol. 6(2), pages 152-177, April.
    2. Emily Evens & Michele Lanham & Catherine Hart & Mores Loolpapit & Isaac Oguma & Walter Obiero, 2014. "Identifying and Addressing Barriers to Uptake of Voluntary Medical Male Circumcision in Nyanza, Kenya among Men 18–35: A Qualitative Study," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-7, June.
    3. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    4. Gopalan, Saji S. & Mutasa, Ronald & Friedman, Jed & Das, Ashis, 2014. "Health sector demand-side financial incentives in low- and middle-income countries: A systematic review on demand- and supply-side effects," Social Science & Medicine, Elsevier, vol. 100(C), pages 72-83.
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    1. Goodkin-Gold, Matthew & Kremer, Michael & Snyder, Christopher M. & Williams, Heidi, 2022. "Optimal vaccine subsidies for endemic diseases," International Journal of Industrial Organization, Elsevier, vol. 84(C).
    2. Wilson, Nicholas, 2021. "Why is ageing associated with lower adoption of new technologies? Evidence from voluntary medical male circumcision and a structural model," The Journal of the Economics of Ageing, Elsevier, vol. 19(C).
    3. Matthew Goodkin-Gold & Michael Kremer & Christopher M. Snyder & Heidi L. Williams, 2020. "Optimal Vaccine Subsidies for Endemic and Epidemic Diseases," NBER Working Papers 28085, National Bureau of Economic Research, Inc.
    4. Camila Perera & Shivit Bakrania & Alessandra Ipince & Zahrah Nesbitt‐Ahmed & Oluwaseun Obasola & Dominic Richardson & Jorinde Van de Scheur & Ruichuan Yu, 2022. "Impact of social protection on gender equality in low‐ and middle‐income countries: A systematic review of reviews," Campbell Systematic Reviews, John Wiley & Sons, vol. 18(2), June.

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