Compensation for transport costs and lost wages associated with VMMC uptake: an intervention to increase VMMC demand among older men in Nyanza Province

Understanding how elements of supply and demand affect uptake of circumcision can play an important role in achieving rapid scale-up of voluntary medical male circumcision (VMMC) in sub-Saharan Africa. Although Kenya has had the most success among countries in sub-Saharan Africa in scaling up VMMC services, there have been challenges in reaching older men (Mwandi et al. 2011, Herman-Roloff et al. 2011). Among men circumcised in Nyanza Province to date, fewer than 10% are ages ?25. Given the higher risk of acquiring HIV in this age group, increasing their uptake of circumcision is likely to have a more immediate impact on population-level HIV incidence. Two important barriers to circumcision that have emerged from qualitative work in the area (Herman-Roloff et al. 2011, Evens et al 2012 unpublished) are the time and transport costs of accessing VMMC services and the hesitation to take time off work on the day of the procedure and during the post-procedure healing period (usually around 1-3 days). Men said they are concerned about providing for their families, in particular making sure they can feed their families while they are unable to work. Addressing these barriers by covering out-of-pocket expenses and other financial costs associated with undergoing VMMC, and building on the success of conditional cash transfer programs in other settings, may yield an effective strategy for increasing circumcision prevalence among older men that is both low-cost and scalable.

Principal Investigator: Harsha Thirumurthy

Funding Source: Bill and Melinda Gates Foundation

Grant Number: OPP1069673

Funding Period: 10/2/2012 - 9/30/2013

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