Economic Compensation to Increase Demand for Voluntary Medical Male Circumcision
Condition: Voluntary Medical Male Circumcision; Circumcision Adult
Study type: Interventional

Summary: 
      Research questions: What effect does provision of food vouchers have on uptake of voluntary
      medical male circumcision? What is the amount of food voucher that should be given?

      Hypothesis: The percentage of men who are compensated for costs of travel to and lost wages
      due to VMMC and who undergo VMMC will be higher than the percentage of men who are
      compensated for lost wages or travel and undergo VMMC, and both of these percentages will be
      higher than the percentage of men who are not compensated for travel or lost wage costs but
      undergo VMMC.
    

Detailed description: 
      Purpose: Implement a randomized trial to test whether offering compensation to older men
      conditional on their coming for medical male circumcision can increase uptake of circumcision
      services.

      Participants: 1,500 uncircumcised men of ages 25-49 in Nyando District, 21 men who chose to
      be circumcised and 21 who did not get circumcised, 10 female partners of men who became
      circumcised and 10 female partners of men who did not will be interviewed

      Procedures (methods): To increase uptake of male circumcision, investigators will offer
      conditional economic compensation for male circumcision. Randomly selected study participants
      will be given the opportunity, conditional on undergoing male circumcision, to obtain food
      vouchers that are intended to offset the cost of accessing the VMMC services and the
      potential lost work the day of the procedure and in the 2 days following the procedure. The
      food vouchers will be given after study participants choose to uptake VMMC services at any of
      the static or outreach sites operated by Impact Research and Development Organization (IRDO).
      Participants will be randomized to one of three intervention groups or to a control group.
      Participants in the intervention groups will have the opportunity to receive a food voucher
      valued at one of three amounts (in KES, Kenyan Shillings) if they choose to get circumcised.
      Participants in the control group will receive a soda but no food voucher if they choose to
      get circumcised. The amounts for the intervention groups were selected based on the
      approximate value of 3 days of work and average transportation costs within the district. The
      amounts were also chosen so that they are not so large as to be perceived as coercive.
      Investigators selected food vouchers instead of cash or mobile phone credit because the
      vouchers were deemed to be more acceptable given the sensitive nature of the intervention and
      men's concern with feeding their families; it was also considered more logistically feasible
      to offer vouchers at the health facilities rather than cash. Additional focus group
      discussions will be held to verify that this form and amount of compensation is acceptable
      and desirable in study communities and if necessary, the intervention can be changed based on
      these results.

      The food vouchers will be valid at dukas (shops) located within the district. At the
      beginning of the study, these shops will be visited and informed about ways to receive cash
      for the vouchers at the central IRDO office in Nyando District. IRDO has previously explored
      the feasibility of implementing the voucher scheme and found that it can be implemented in
      the study areas.

      Three months after enrollment of study participants, investigators will conduct qualitative
      research in which there will be in-depth interviews with a small sample of men who did and
      did not come for circumcision and with their partners. Three topics will be examined in the
      qualitative interview: men's decision-making, logistics of the intervention, and women's
      perceptions.
    

Intervention name(s): Compensation for transport cost; Compensation for lost wages; Compensation for transport cost and lost wages; Standard of Care
Intervention type(s): Other; Other; Other; Other
Intervention description(s): Consistent with standard of care, participants in this group will be offered a refreshment during their office visit.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Prevention