The Use of Peer Referral Incentives to Increase Demand for Voluntary Medical Male Circumcision in Zambia
Condition: HIV Infection
MeSH terms: HIV Infections
Study type: Interventional

Summary: 
      The Centre for Infectious Disease Research in Zambia (CIDRZ) and researchers from the
      University of North Carolina at Chapel Hill (UNC) have partnered to pilot an peer-referral
      incentive program to increase voluntary medical male circumcision (VMMC) uptake in Zambia.
      The program allows each man coming for circumcision to refer up to 5 uncircumcised men in
      their social network for VMMC services and receive a monetary reward for each successful
      referral. The peer-referral program offers several advantages over traditional
      demand-creation approaches that rely on employing mobilizers or community health workers
      (CHWs). The amount of the monetary incentive will be analogous to the amount of incentive
      that CHWs might receive for comparable effort, making the program suitable for large-scale
      expansion. The effect of the peer-referral program on uptake of VMMC services will be
      evaluated using a rigorous methodology proposed by UNC researchers.
    

Detailed description: 
      The investigators propose a cluster randomized design in which the CIDRZ-supported VMMC
      clinics in the Southern Province in Zambia will be randomly selected to have a peer referral
      incentive program or not. In approximately 10 randomly selected intervention clinics, all men
      who reside in the catchment area of the clinic and come for male circumcision services will
      be eligible to receive 5 referral vouchers that will entitle them to receive monetary
      compensation for each voucher that is subsequently presented by a man who comes to the clinic
      and undergoes male circumcision. In 10 remaining clinics (control group), VMMC services will
      proceed as per the current standard of care, without peer referral incentives. All clinics
      including those allocated to the control group will have the standard mobilization and
      promotion activities that are used by CIDRZ.

      In intervention clinics:

        -  All eligible men seeking VMMC in intervention clinics will be asked if they want to
           participate in the study. This can happen on the day of the circumcision or within 7
           days after the circumcision.

        -  If yes, a file is open for them as "referring person". They receive 5 vouchers. They
           also receive MC brochures to distribute to friends.

        -  As his friends or relatives come in as referrals, they are written in his file He can
           then claim reimbursement any time between the time a referred friend comes for VMMC and
           the expiration of the voucher. The referring person needs to bring the voucher in order
           to receive reimbursement.

        -  Friends who come as referrals are given the possibility to become referring persons too,
           if within the intervention period. In that case, a new file is open for them as
           "referring persons".
    

Intervention name(s): Peer-referral incentive program to increase VMMC uptake
Intervention type(s): Other
Intervention description(s): The proposed intervention will allow men coming for male circumcision in randomly selected intervention clinics to refer up to 5 uncircumcised men in their social network and receive a monetary reward for each referred man who undergoes male circumcision. Men who come for circumcision will each be given 5 referral vouchers that they can then provide to uncircumcised men in their social network who may be interested in undergoing VMMC. If these uncircumcised men come to the CIDRZ VMMC clinics and undergo the circumcision procedure, they can present the referral voucher to clinic staff who will then retain the voucher until the man who made the referral comes to collect his incentive payment.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Keywords: Uncircumcised men; Voluntary Medical Male circumcision; Peer-referral incentive