title: A Randomized Evaluation of a Demand Creation Lottery for Voluntary Medical Male Circumcision Among Adults in Tanzania.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: *Jhpiego, Baltimore, MD; †FHI 360, Washington, DC (formerly Jhpiego, Dar es Salaam, Tanzania); ‡Jhpiego, Dar es Salaam, Tanzania; §Ministry of Health, Community Development, Gender, the Elderly and Children, Dar es Salaam, Tanzania; ‖Jhpiego/Consultant, Baltimore, MD; and ¶Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA.
authors.forename: Eva
authors.initials: E
authors.lastname: Bazant
authors.forename: Hally
authors.initials: H
authors.lastname: Mahler
authors.forename: Michael
authors.initials: M
authors.lastname: Machaku
authors.forename: Ruth
authors.initials: R
authors.lastname: Lemwayi
authors.forename: Yusuph
authors.initials: Y
authors.lastname: Kulindwa
authors.forename: Jackson
authors.initials: J
authors.lastname: Gisenge Lija
authors.forename: Baraka
authors.initials: B
authors.lastname: Mpora
authors.forename: Denice
authors.initials: D
authors.lastname: Ochola
authors.forename: Supriya
authors.initials: S
authors.lastname: Sarkar
authors.forename: Emma
authors.initials: E
authors.lastname: Williams
authors.forename: Marya
authors.initials: M
authors.lastname: Plotkin
authors.forename: James
authors.initials: J
authors.lastname: Juma
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D000068997:Smartphone; D013636:Tanzania; D055815:Young Adult