title: The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya: A Randomized Trial.
abstract: BACKGROUND
  Effective demand creation strategies are needed to increase uptake of medical male circumcision and reduce new HIV infections in eastern and southern Africa. Building on insights from behavioral economics, we assessed whether providing compensation for opportunity costs of time or lottery-based rewards can increase male circumcision uptake in Kenya.
  
  
  METHODS
  Uncircumcised men aged 21-39 years were randomized in 1:1:1 ratio to 2 intervention groups or a control group. One intervention group was offered compensation of US $12.50 conditional on circumcision uptake. Compensation was provided in the form of food vouchers. A second intervention group was offered the opportunity to participate in a lottery with high-value prizes on undergoing circumcision. The primary outcome was circumcision uptake within 3 months.
  
  
  RESULTS
  Among 903 participants enrolled, the group that received compensation of US $12.50 had the highest circumcision uptake (8.4%, 26/308), followed by the lottery-based rewards group (3.3%, 10/302), and the control group (1.3%, 4/299). Logistic regression analysis showed that compared with the control group, the fixed compensation group had significantly higher circumcision uptake [adjusted odds ratio 7.1; 95% CI: 2.4 to 20.8]. The lottery-based rewards group did not have significantly higher circumcision uptake than the control group (adjusted odds ratio 2.5; 95% CI: 0.8 to 8.1).
  
  
  CONCLUSIONS
  Providing compensation was effective in increasing circumcision uptake among men over a short period. The results are consistent with studies showing that such interventions can modify health behaviors by addressing economic barriers and behavioral biases in decision making. Contrary to findings from studies of other health behaviors, lottery-based rewards did not significantly increase circumcision uptake.
  
  
  BACKGROUND
  Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107.
authors.affiliation: *Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Impact Research and Development Organization, Kisumu, Kenya; §Final Mile, Mumbai, India; and ‖University of California San Diego, San Diego, CA.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Masters
authors.forename: Samwel
authors.initials: S
authors.lastname: Rao
authors.forename: Kate
authors.initials: K
authors.lastname: Murray
authors.forename: Ram
authors.initials: R
authors.lastname: Prasad
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Zivin
authors.forename: Eunice
authors.initials: E
authors.lastname: Omanga
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
mesh_terms: D000328:Adult; D002944:Circumcision, Male / Q000706:statistics & numerical data*; D035881:Compensation and Redress; D006801:Humans; D007630:Kenya; D008297:Male; D012201:Reward; D055815:Young Adult