THE IMPACTS OF A DEMAND-SIDE VMMC INCENTIVES PROGRAM ON THE MALE CIRCUMCISION RATE IN 2 DISTRICTS IN MALAWI: A SYNTHETIC CONTROL APPROACH
Joint Event on International Conference on STRUCTURAL BIOLOGY AND PROTEOMICS & International Conference on STD-AIDS AND INFECTIOUS DISEASES
September 03-04, 2018 | Bangkok ,Thailand
National AIDS Commission, Malawi
Scientific Tracks Abstracts : J Genet Mol Biol
Background: The study aimed to evaluate the effect of incentives on improving the uptake of VMMC. The primary research question sought to find out whether provision of incentives can significantly increase VMMC uptake among in-school and out-of-school boys and young men aged 10 to 34 in Malawi. Uptake of VMMC among eligible 10-34 years old males has been slow and Malawi Government sought to identify evidence-based innovative solutions to increase VMMC uptake. In this light, the Malawi National AIDS Commission undertook a study of using incentives to create VMMC demand in Mchinji and Rumphi districts from October 2015 to April 2016. School heads and community-based mothersâ groups offered vouchers to potential circumcision clients and their caretakers and a second set to hand out to their friends and caregivers â that covered the cost of transport for them and their caregiver for the procedures and two follow-up visits. Methods: Synthetic control methods were used to estimate the causal effect of the program on the circumcision rate of males 10-34 years old. Information on VMMC rates for the two years before study onset, as well as district-level socio-demographic and health information, inform the synthetic counterfactual for each of the study districts. Permutation tests establish the robustness of the impact estimates. Findings: The program led to a substantial increase in circumcisions: an additional 16.05 male circumcisions per 1,000 adult males in Rumphi, and an additional 9.15 in Mchinji. Overall, an individual who received a voucher was seven times more likely to be circumcised than someone who had not received one. Complementary qualitative findings suggest that mothersâ groups were more effective in motivating young men due to personal attention and that caregivers and informal networks play an important supportive function in the circumcision decision. Conclusions: Despite implementation challenges, the demand-side VMMC program is highly effective in increasing the circumcision rate from low baseline levels.
Suzi Joel is behavior change specialist currently heading HIV combination prevention and social and behavior change programmes for the Malawi National AIDS Commission. He holds a Master of Arts degree in Communication in Development from the University of Malawi and a first degree in Humanities Minoring in Demography from the same university. He has over 13 years of experience in HIV and health program and policy development and management, research and evaluation. He has conducted research and published five papers on non-biomedical HIV and integrated health programming. He has previously worked with Johns Hopkins University Center for Communication Programs in Malawi on several projects coordinating integrated health communication programmes.