title: A Sport-Based Intervention to Increase Uptake of Voluntary Medical Male Circumcision Among Adolescent Male Students: Results From the MCUTS 2 Cluster-Randomized Trial in Bulawayo, Zimbabwe.
abstract: BACKGROUND
  Mathematical models suggest that 570,000 HIV infections could be averted between 2011 and 2025 in Zimbabwe if the country reaches 80% voluntary medical male circumcision (VMMC) coverage among 15- to 49-year-old male subjects. Yet national coverage remains well below this target, and there is a need to evaluate interventions to increase the uptake.
  
  
  METHODS
  A cluster-randomized trial was conducted to assess the effectiveness of Make-The-Cut-Plus (MTC+), a single, 60-minute, sport-based intervention to increase VMMC uptake targeting secondary school boys (14-20 years). Twenty-six schools in Bulawayo, Zimbabwe, were randomized to either receive MTC+ at the start (intervention) or end (control) of a 4-month period (March to June 2014). VMMC uptake over these 4 months was measured via probabilistic matching of participants in the trial database (n = 1226 male participants; age, 14-20 years; median age, 16.2 years) and the registers in Bulawayo's 2 free VMMC clinics (n = 5713), using 8 identifying variables.
  
  
  RESULTS
  There was strong evidence that the MTC+ intervention increased the odds of VMMC uptake by approximately 2.5 fold (odds ratio = 2.53; 95% confidence interval, 1.21 to 5.30). Restricting to participants who did not report being already circumcised at baseline, MTC+ increased VMMC uptake by 7.6% (12.2% vs 4.6%, odds ratio = 2.65; 95% confidence interval, 1.19 to 5.86). Sensitivity analyses related to the probabilistic matching did not change these findings substantively. The number of participants who would need to be exposed to the demand creation intervention to yield one additional VMMC client was 22.7 (or 13.2 reporting not already being circumcised). This translated to approximately US dollar 49 per additional VMMC client.
  
  
  CONCLUSIONS
  The MTC+ intervention was an effective and cost-effective strategy for increasing VMMC uptake among school-going adolescent male subjects in Bulawayo.
authors.affiliation: *Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom; †Department of Health Behavior, University of North Carolina-Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC; ‡Department of Health Policy & Management, University of North Carolina, Chapel Hill, NC; §Grassroot Soccer Zimbabwe, Bulawayo, Zimbabwe; ‖Department of Nursing and Midwifery Sciences, National University of Science and Technology, Bulawayo, Zimbabwe; and ¶Population Services International Zimbabwe, Harare, Zimbabwe.
authors.forename: Zachary A
authors.initials: ZA
authors.lastname: Kaufman
authors.forename: Jeff
authors.initials: J
authors.lastname: DeCelles
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bhauti
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: Hershow
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.forename: Cynthia
authors.initials: C
authors.lastname: Chaibva
authors.forename: Netsai
authors.initials: N
authors.lastname: Moyo
authors.forename: Fennie
authors.initials: F
authors.lastname: Mantula
authors.forename: Karin
authors.initials: K
authors.lastname: Hatzold
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D006801:Humans; D008297:Male; D015397:Program Evaluation; D013177:Sports; D013334:Students; D055815:Young Adult