Medical male circumcision: How does price affect the risk-profile of take-up?

Thornton, Rebecca; Godlonton, Susan

doi:10.1016/j.ypmed.2016.06.003

Cited by 5 publications

(16 citation statements)

References 16 publications

(14 reference statements)

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“…Thornton et al . studied the effect of offering subsidized circumcision (at different rates) on VMMC uptake . Discounting the cost to $0 did not lead to a significant increase in VMMC uptake compared to the men paying between $0.55 and $6.75 for the procedure (OR 1.3 (0.7 to 2.6)).…”

Section: Resultsmentioning

confidence: 99%

“…Interventions were categorized into four major types: (i) financial incentives, (ii) counselling or education for prospective candidates, (iii) education and involvement of influencers, and (iv) novel information delivery, although some included more than one of these approaches. Most (n = 13) studies [13,[16][17][18][19][20][21]28,29,[31][32][33][34] presented data on the number of circumcisions completed at the end of the study period, while the remaining two studies [30,35] reported the prevalence of circumcision in the cohort. Table 2 shows the key findings from each study with both relative and absolute effects (where reported in the paper or calculated from raw data).…”

Section: Quantitative Resultsmentioning

confidence: 99%

“…There was a non-significant increase in the absolute number of VMMCs performed in both the intervention and control facilities compared to the number performed in the same facilities during the previous 12 months (47% (p = 0.150) and 8% (p = 0.850) respectively) [13]. The RCT by [32]. Discounting the cost to $0 did not lead to a significant increase in VMMC uptake compared to the men paying between $0.55 and $6.75 for the procedure (OR 1.3 (0.7 to 2.6)).…”

Section: Financial Incentivesmentioning

confidence: 93%

“…The 18 papers included were published between 2014 and 2018 and presented data associated with 16 studies; five cluster randomised control trials (CRCTs) [13,14,16,[28][29][30], six RCTs [17,19,20,[31][32][33], two prospective interventional cohorts [34,35], two quasi-experimental [18,36] and one "non-experimental" study (amended from an RCT due to delays with VMMC service implementation) [21] (Table 1). Studies took place across seven countries in SSA.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 3 more Smart Citations

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

et al. 2019

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Introduction UNAID S has recommended that in 14 countries across sub‐Saharan Africa ( SSA ), 90% of men aged 10 to 29 years should be circumcised by 2021 to help reduce transmission of HIV . To achieve this target demand creation programmes have been widely implemented to increase demand for Voluntary Medical Male Circumcision ( VMMC ). This review explores the effectiveness of demand creation interventions and factors affecting programme implementation. Methods We completed a mixed methods systematic review searching Medline, Embase, Global health, psyc INFO and CINAHL databases in August 2018 with no time restrictions. Demand creation interventions conducted in SSA were categorized and quantitative data about VMMC uptake was used to compare relative and absolute effectiveness of interventions. Qualitative data were summarized into themes relevant to the delivery and impact of programmes. Results and discussion Eighteen of the 904 titles were included in the review. Effective interventions were identified in each demand creation category: financial incentives, counselling or education, involvement of influencers and novel information delivery. Of the 11 randomized controlled trials ( RCT s), the greatest absolute impact on VMMC prevalence was seen with a complex intervention including VMMC promotion training for religious leaders (compared to control: 23% (95% CI 22.8 to 23.8) absolute increase; odds ratio ( OR ) 3.2 (1.4 to 7.3)). Financial incentives generally produced the largest relative effects with men up to seven‐times more likely to undergo VMMC in the intervention arm compared to control (adjusted OR 7.1 (95% CI 2.4 to 20.8), 7.1% (3.7 to 10.5) absolute increase). Qualitative findings suggest that interventions are more impactful when they are judged appropriate and acceptable by the target population; delivered by people with relevant personal experience; and addressing broader social and cultural influences through partnership with and education of community leaders. Conclusions A range of demand creation interventions can increase VMMC uptake. The most acceptable and effective interventions are financial incentives framed as fair compensation (relative effect) and programmes of education or counselling delivered by people who are influential in the community (absolute effect). Future research should include larger studies with longer follow‐up and a consistent definition of VMMC uptake.

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Section: Resultsmentioning

confidence: 99%

Section: Quantitative Resultsmentioning

confidence: 99%

Section: Financial Incentivesmentioning

confidence: 93%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

et al. 2019

View full text Add to dashboard Cite

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“…Moving to international health research, Thornton and Godlonton (2016—in this issue) report on the efficacy of offering vouchers to subsidize the cost of adult medical circumcision among men at-risk for sexually-transmitted HIV infection in Malawi. Importantly, their study demonstrates that only lowering the cost to zero (full-cost subsidy) is effective at increasing circumcision among men in the highest risk group.…”

Section: Leveraging Behavioral Sciencementioning

confidence: 99%

Editorial: 3rd Special Issue on behavior change, health, and health disparities

Higgins

2016

Preventive Medicine

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This Special Issue of Preventive Medicine (PM) is the 3rd that we have organized on behavior change, health, and health disparities. This is a topic of critical importance to improving U.S. population health. There is broad scientific consensus that personal behaviors such as cigarette smoking, other substance abuse, and physical inactivity/obesity are among the most important modifiable causes of chronic disease and its adverse impacts on population health. Hence, effectively promoting health-related behavior change needs to be a key component of health care research and policy. There is also broad recognition that while these problems extend throughout the population, they disproportionately impact economically disadvantaged populations and other vulnerable populations and represent a major contributor to health disparities. Thus, behavior change represents an essential step in curtailing health disparities, which receives special attention in this 3rd Special Issue. We also devote considerable space to the longstanding challenges of reducing cigarette smoking and use of other tobacco and nicotine delivery products in vulnerable populations, obesity, and for the first time food insecurity. Across each of these topics we include contributions from highly accomplished policymakers and scientists to acquaint readers with recent accomplishments as well as remaining knowledge gaps and challenges.

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The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review

et al. 2023

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By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps. Keywords Urban • Poverty • Sexual and reproductive health and rightsElsie Akwara and Jessie Pinchoff contributed equally to this work.

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Medical male circumcision: How does price affect the risk-profile of take-up?

Cited by 5 publications

References 16 publications

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub‐Saharan Africa: a mixed methods systematic review

Editorial: 3rd Special Issue on behavior change, health, and health disparities

The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review

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