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. 2020 Jan 23;21(1):108.
doi: 10.1186/s13063-020-4048-2.

Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, East Zimbabwe: study protocol for a pilot randomised trial

Ranjeeta Thomas  1 , Morten Skovdal  2 , Matteo M Galizzi  3 , Robin Schaefer  4 , Louisa Moorhouse  4 , Constance Nyamukapa  4   5 , Rufurwokuda Maswera  5 , Phyllis Mandizvidza  5 , Timothy B Hallett  4 , Simon Gregson  4
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Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, East Zimbabwe: study protocol for a pilot randomised trial

Ranjeeta Thomas et al. Trials. .

Abstract

Background: Voluntary medical male circumcision (VMMC) is a key component of combination HIV-prevention programmes. Several high-HIV-prevalence countries in sub-Saharan Africa, including Zimbabwe, are looking to scale up VMMC activities. There is limited evidence on how a combination of social learning from peer education by a role model with different behavioural incentives influences demand for VMMC in such settings.

Methods/design: This matched-cluster randomised controlled trial with 1740 participants will compare two behavioural incentives against a control with no intervention. In the intervention clusters, participants will participate in an education session delivered by a circumcised young male ("role model") on the risks of HIV infection and the benefits from medical male circumcision. All participants will receive contributions towards transport costs to access medical male circumcision at participating clinics. Via blocked randomisation, in the intervention clusters participants will be randomly assigned to receive one of two types of incentives - fixed cash payment or lottery payment - both conditional on undergoing surgical VMMC. In two sites, a community-led intervention will also be implemented to address social obstacles and to increase support from peers, families and social structures. Baseline measures of endpoints will be gathered in surveys. Follow-up assessment at 6 months will include self-reported uptake of VMMC triangulated with clinic data.

Discussion: This is the first trial to pilot-test social learning to improve risk perception and self-efficacy and to address the fear of pain associated with VMMC and possible present-biased preferences with front-loaded compensations as well as fixed or lottery-based cash payments. This study will generate important knowledge to inform HIV-prevention policies about the effectiveness of behavioural interventions and incentives, which could be easily scaled-up.

Trial registration: This trial has been registered on ClinicalTrials.gov (identifier: NCT03565588). Registered on 21 June 2018.

Keywords: HIV prevention; Incentives; Medical male circumcision; Randomised trial; Zimbabwe.

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Conflict of interest statement

SG declares shares in GlaxoSmithKline and AstraZeneca. TBH declares grants outside the subject area from UNAIDS (Joint United Nations Programme on HIV and AIDS), the World Health Organization, the BMGF, and the MRC. RT declares grants outside the subject area from the European and Developing Countries Clinical Trials Partnership. The other authors declare that they have no competing interests.

Figures

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Fig. 1
Study design
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Fig. 2
Study schedule of events
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