title: Effect of providing conditional economic compensation on uptake of voluntary medical male circumcision in Kenya: a randomized clinical trial.
abstract: OBJECTIVE
  Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy.
  
  
  OBJECTIVE
  To determine whether small economic incentives could increase circumcision prevalence by addressing reported economic barriers to VMMC and behavioral factors such as present-biased decision making.
  
  
  METHODS
  Randomized clinical trial conducted between June 22, 2013, and February 4, 2014, among 1504 uncircumcised men aged 25 to 49 years in Nyanza region, Kenya. VMMC services were provided free of charge and participants were randomized to 1 of 3 intervention groups or a control group.
  
  
  METHODS
  Participants in the 3 intervention groups received varying amounts of compensation conditional on undergoing circumcision at 1 of 9 study clinics within 2 months of enrollment. Compensation took the form of food vouchers worth 200 Kenya shillings (≈ US $2.50), 700 Kenya shillings (≈ US $8.75), or 1200 Kenya shillings (≈ US $15.00), which reflected a portion of transportation costs and lost wages associated with getting circumcised. The control group received no compensation.
  
  
  METHODS
  VMMC uptake within 2 months.
  
  
  RESULTS
  Analysis of data for 1502 participants with complete data showed that VMMC uptake within 2 months was higher in the US $8.75 group (6.6%; 95% CI, 4.3%-9.5% [25 of 381]) and the US $15.00 group (9.0%; 95% CI, 6.3%-12.4% [34 of 377]) than in the US $2.50 group (1.9%; 95% CI, 0.8%-3.8% [7 of 374]) and the control group (1.6%; 95% CI, 0.6%-3.5% [6 of 370]). In logistic regression analysis, the US $8.75 group had significantly higher VMMC uptake than the control group (adjusted odds ratio [AOR] 4.3; 95% CI, 1.7-10.7), as did the US $15.00 group (AOR 6.2; 95% CI, 2.6-15.0). Effect sizes for the US $8.75 and US $15.00 groups did not differ significantly (P = .20).
  
  
  CONCLUSIONS
  Among uncircumcised men in Kenya, compensation in the form of food vouchers worth approximately US $8.75 or US $15.00, compared with lesser or no compensation, resulted in a modest increase in the prevalence of circumcision after 2 months. The effects of more intense promotion or longer implementation require further investigation.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01857700.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill2Carolina Population Center, University of North Carolina at Chapel Hill.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Masters
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Samwel
authors.initials: S
authors.lastname: Rao
authors.affiliation: Carolina Population Center, University of North Carolina at Chapel Hill.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Bronson
authors.affiliation: FHI 360, Durham, North Carolina.
authors.forename: Michele
authors.initials: M
authors.lastname: Lanham
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Eunice
authors.initials: E
authors.lastname: Omanga
authors.affiliation: FHI 360, Durham, North Carolina.
authors.forename: Emily
authors.initials: E
authors.lastname: Evens
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000191:economics* / Q000706:statistics & numerical data; D003657:Decision Making; D005382:Financing, Personal; D005502:Food / Q000191:economics; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009042:Motivation