Conditional Cash Transfers To Promote Male Circumcision Uptake In Middle And Low Income Countries: Review
Volume 1 - Issue 5, November 2017 Edition
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Author(s)
Jacques Lukenze Tamuzi , Jonathan Lukusa Tshimwanga , Ley Muyaya Muyaya , Esperance Musanda Manwana
Keywords
VMMC; conditional cash transfer; HIV
Abstract
Background: Voluntary medical male circumcision (VMMC) reduces female-to-male HIV transmission by approximately 60% and is a recommended HIV prevention strategy in countries with high HIV prevalence and low levels of male circumcision. Mathematical models have illustrated that VMMC scale-up across Sub-Saharan Africa could prevent up to 6 million new HIV infections and 3 million deaths by 2025. Compared to the epidemic impact of scaling up ART to 90-90-90 levels, VMMC scale-up demonstrated additional reductions in HIV incidence and lower long-term annual program costs in models applied to several Sub-Saharan African countries. Therefore, low income countries are facing several challenges among which economic factors such as lost wages and opportunity costs of time are likely to be important barriers for VMMC uptake. Conditional cash transfers have shown its efficacy in many studies conducting low and middle countries where economic factors are impacting negatively on VMMC. Objectives: to assess the effectiveness of cash transfers to improve voluntary medical male circumcision. Methods: We searched eligible studies through each database from January 2017 to April 2017. We used the key words added with Boolean operators to search studies. The following databases were assessed: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), Scopus, CINAHL and Web of Science (WOS). We also searched ongoing RCTs through: ClinicalTrials.gov (www.clinicaltrials.gov/) and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal (apps.who.int/trialsearch/). We included randomized control trials that evaluated the impact of conditional cash transfers on male circumcision. All included studies were selected in low and middle income countries. JT identified studies through different database. JT and LM independently assessed eligible studies that met inclusion criteria. We used the statistical package RevMan 5.3 provided by Cochrane. As heterogeneity among included studies was not important, we conducted meta-analysis. We reported the typical (if at least two trials were included) odds ratio. All values were reported with their 95% CIs. Results : the main result has shown that conditional cash transfer was 4.78 times more likely to improve VMMC compared to the control group (OR 4.78 95%CI 4.17 to 5.48, 6286 participants, 6 studies, P< 0.00001). Heterogeneity: Chi² = 8.97, df = 5 (P = 0.11); I² = 44%. The evidence was graded high. Conclusion: based on the results, we can conclude that conditional cash transfer is beneficial in improving VMMC. The quality of evidence was judged high so this review could play an important role in VMMC policy in middle and low income countries.
References
[1] Bazant E, Mahler H, Machaku M, Lemwayi R, Kulindwa Y, Gisenge Lija J, et al. A Randomized Evaluation of a Demand Creation Lottery for Voluntary Medical Male Circumcision Among Adults in Tanzania. Journal of acquired immune deficiency syndromes (1999) 2016;72 Suppl 4:S280-7.
[2] Marshall E, Rain-Taljaard R, Tsepe M, Monkwe C, Taljaard D, Hlatswayo F, et al. Obtaining a male circumcision prevalence rate of 80% among adults in a short time: An observational prospective intervention study in the Orange Farm township of South Africa. Medicine 2017;96(4):e5328.
[3] Thirumurthy H, Masters SH, Rao S, Bronson MA, Lanham M, Omanga E, et al. Effect of providing conditional economic compensation on uptake of voluntary medical male circumcision in Kenya: a randomized clinical trial. JAMA 2014;312(7):703-11.
[4] Thirumurthy H, Masters SH, Rao S, Murray K, Prasad R, Zivin JG, et al. The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya: A Randomized Trial. Journal of acquired immune deficiency syndromes (1999) 2016;72 Suppl 4:S299-305.
[5] Wilson N, Frade S, Rech D, Friedman W. Advertising for demand creation for voluntary medical male circumcision. Journal of acquired immune deficiency syndromes 2017;72:S293-6. [DOI: 10.1097/QAI.0000000000001039; Other: CN-01288528]
[6] Zanolini A, Bolton C, Lyabola LL, Phiri G, Samona A, Kaonga A, et al. Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia. Journal of acquired immune deficiency syndromes (1999) 2016;72 Suppl 4:S257-63.
[7] Djimeu EW, Brown AN. Strength of Evidence on Demand Creation for Voluntary Medical Male Circumcision From 7 Impact Evaluations in Southern and Eastern Africa. Journal of acquired immune deficiency syndromes (1999) 2016;72 Suppl 4:S321-5.
[8] Evens E, Lanham M, Murray K, Rao S, Agot K, Omanga E, et al. Use of Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision in Kenya: Qualitative Interviews With Male Participants in a Randomized Controlled Trial and Their Partners. Journal of acquired immune deficiency syndromes (1999) 2016;72 Suppl 4:S306-10.
[9] Green LW; McAllister RG; Peterson KW; Travis JW; Leibowitz AA; Desmond K; Belin T. MEDICAID COVERAGE OF CIRCUMCISION SPREADS HARM TO THE POOR. American Journal of Public Health 2011;99:4.
[10] Sgaier SK, Reed JB, Sundaram M, Brown A, Djimeu E, Ridzon R. Interventions to Drive Uptake of Voluntary Medical Male Circumcision-A Collection of Impact Evaluation Evidence. Journal of acquired immune deficiency syndromes (1999) 2016;72 Suppl 4:S257-61.
[11] Amuri M, Msemo G, Plotkin M, Christensen A, Boyee D, Mahler H, et al. Bringing Early Infant Male Circumcision Information Home to the Family: Demographic Characteristics and Perspectives of Clients in a Pilot Project in Tanzania. Global health, science and practice 2016;4 Suppl 1:S29-41.
[12] Auvert B, Sobngwi-Tambekou J, Cutler E, Nieuwoudt M, Lissouba P, Puren A, et al. Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in Orange Farm, South Africa. The Journal of infectious diseases 2009;199(1):14-9.
[13] Bailey RC, Moses S, Parker CB, Agot K, Maclean I, Krieger JN, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet (London, England) 2007;369(9562):643-56.
[14] Chilimampunga C, Lijenje S, Sherman J, Nindi K, Mavhu W. Acceptability and feasibility of early infant male circumcision for HIV prevention in Malawi. PloS one 2017;12(4):e0175873.
[15] Chinkhumba J, Godlonton S, Thonton L. Demand for medical malecircumcision. Am Econ J Appl Econ 2011;6:152-177
[16] Donoval BA, Landay AL, Moses S, Agot K, Ndinya-Achola JO, Nyagaya EA, et al. HIV-1 target cells in foreskins of African men with varying histories of sexually transmitted infections. American journal of clinical pathology 2006;125(3):386-91
[17] Doyle SM, Kahn JG, Hosang N, Carroll PR. The impact of male circumcision on HIV transmission. The Journal of urology 2010;183(1):21-6.
[18] Gray RH, Kigozi G, Serwadda D, Makumbi F, Watya S, Nalugoda F, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial. Lancet (London, England) 2007;369(9562):657-66.
[19] Gray R, Kigozi G, Kong X, Ssempiija V, Makumbi F, Wattya S, et al. The effectiveness of male circumcision for HIV prevention and effects on risk behaviors in a posttrial follow-up study. AIDS (London, England) 2012;26(5):609-15.
[20] Hargrove J, Williams B, Abu-Raddad L, Auvert B, Bollinger L, Dorrington R, et al.. Male circumcision for HIV prevention in high HIV prevalence settings: what can mathematical modelling contribute to informed decision making? PLoS medicine 2009;6(9):e1000109.
[21] Herman-Roloff A, Llewellyn E, Obiero W, Agot K, Ndinya-Achola J, Muraguri N, et al. Implementing voluntary medical male circumcision for HIV prevention in Nyanza Province, Kenya: lessons learned during the first year. PloS one 2011;6(4):e18299.
[22] Kaufman MR, Smelyanskaya M, Van Lith LM, Mallalieu EC, Waxman A, Hatzhold K, et al. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review. PloS one 2016;11(3):e0149892.
[23] Kibira SP, Daniel M, Atuyambe LM, Makumbi FE, Sandoy IF. Exploring drivers for safe male circumcision: Experiences with health education and understanding of partial HIV protection among newly circumcised men in Wakiso, Uganda. PloS one 2017;12(3):e0175228.
[24] Kigozi G, Wawer M, Ssettuba A, Kagaayi J, Nalugoda F, Watya S, et al. Foreskin surface area and HIV acquisition in Rakai, Uganda (size matters). AIDS (London, England) 2009;23(16):2209-13.
[25] Kikaya V, Kakaire R, Thompson E, Ramokhele M, Adamu T, Curran K, et al. Scale-Up of Early Infant Male Circumcision Services for HIV Prevention in Lesotho: A Review of Facilitating Factors and Challenges. Global health, science and practice 2016;4 Suppl 1:S87-96.
[26] Kripke K, Reed J, Hankins C, Smiley G, Laube C, Njeuhmeli E. Impact and Cost of Scaling Up Voluntary Medical Male Circumcision for HIV Prevention in the Context of the New 90-90-90 HIV Treatment Targets. PloS one 2016;11(10):e0155734.
[27] Kripke K, Chimbwandira F, Mwandi Z, Matchere F, Schnure M, Reed J, et al. Correction: Voluntary Medical Male Circumcision for HIV Prevention in Malawi: Modeling the Impact and Cost of Focusing the Program by Client Age and Geography. PloS one 2017;12(1):e0169708.
[28] Lilleston PS, Marcell AV, Nakyanjo N, Leonard L, Wawer MJ. Multilevel influences on acceptance of medical male circumcision in Rakai District, Uganda. AIDS care 2017;1-7.
[29] Lissouba P, Taljaard D, Rech D, Dermaux-Msimang V, Legeai C, Lewis D, et al. Adult male circumcision as an intervention against HIV: an operational study of uptake in a South African community (ANRS 12126). BMC infectious diseases 2011;11:253.
[30] Luo C. Sustaining Gains Made in Voluntary Medical Male Circumcision. Global health, science and practice 2016;4 Suppl 1:S1-2.
[31] Maraux B, Lissouba P, Rain-Taljaard R, Taljaard D, Bouscaillou J, Lewis D, et al. Women's knowledge and perception of male circumcision before and after its roll-out in the South African township of Orange Farm from community-based cross-sectional surveys. PloS one 2017;12(3):e0173595.
[32] Mavhu W, Hatzold K, Ncube G, Fernando S, Mangenah C, Chatora K, et al. Unpacking early infant male circumcision decision-making using qualitative findings from Zimbabwe. BMC international health and human rights 2017;17(1):2.
[33] Male circumcision for HIV prevention: research implications for policy and programming. WHO/UNAIDS technical consultation, 6-8 March 2007. Conclusions and recommendations (excerpts). Reproductive health matters 2007;15(29):11-4.
[34] Nurminen M. On the epidemiologic notion of confounding and confounder identification. Scandinavian journal of work, environment & health 1997;23(1):64-8.
[35] Plank RM, Makhema J, Kebaabetswe P, Hussein F, Lesetedi C, Halperin D, et al. Acceptability of infant male circumcision as part of HIV prevention and male reproductive health efforts in Gaborone, Botswana, and surrounding areas. AIDS and behavior 2010;14(5):1198-202.
[36] Plotkin M, Hawa Mziray H, Küver J, et al. Embe Halijamenywa: TheUnpeeled Mango: A Qualitative Assessment of Views and Preferences onVoluntary Medical Male Circumcision in Iringa Region, Tanzania.Iringa, Africa: MCHIP. 2011.
[37] Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, et al. Male circumcision for prevention of heterosexual acquisition of HIV in men. The Cochrane database of systematic reviews 2003;(3):CD003362.
[38] UNAIDS. The GAP report. Geneva: Joint United Nations Programmeon HIV/AIDS. Geneva: 2014, UNAIDS.
[39] UNICEF. Early infant male circumcision: report of a global partners meeting, Johannesburg, SouthAfrica. UNICEF, 2014.
[40] Wanyama OJ, Kaweesa KD, Kirungi W, Odiit M, Wabwire-Mangen F. UgandaHIV prevention response and modes of transmission analysis. Kampala:Uganda national AIDS commission. UNAIDS, 2009.
[41] Weiss HA, Quigley MA, Hayes RJ. Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and meta-analysis. AIDS (London, England) 2000;14(15):2361-70.
[42] Weiss HA, Halperin D, Bailey RC, Hayes RJ, Schmid G, Hankins CA. Male circumcision for HIV prevention: from evidence to action? AIDS (London, England) 2008;22(5):567-74.
[43] Westercamp N, Bailey RC. Acceptability of male circumcision for prevention of HIV/AIDS in sub-Saharan Africa: a review. AIDS and behavior 2007;11(3):341-55.
[44] Westercamp M, Bailey RC, Bukusi EA, Montandon M, Kwena Z, Cohen CR. Male circumcision in the general population of Kisumu, Kenya: beliefs about protection, risk behaviors, HIV, and STIs. PloS one 2010;5(12):e15552.
