Grassroot Soccer (DeCelles, Hershow); London School of Hygiene & Tropical Medicine (Kaufman, Weiss, Braunschweig, Ross); Grassroot Soccer Zimbabwe (Bhauti, Moyo); National University of Science and Technology (Mantula, Chaibva); Population Services International (Hatzold)
"Despite progress in supply scale-up, Zimbabwe is falling well short of its target of 80 per cent VMMC coverage by 2015 (WHO 2011), underlining the urgent need to identify and scale up effective interventions that increase demand for VMMC."
This report looks at the results of an impact evaluation of the Make The Cut Plus(MTC+) project - a short, sport-based intervention, delivered by Grassroot Soccer, that aims to increase demand for voluntary medical male circumcision (VMMC) among adolescent male students (aged 15 to 19 years) in secondary schools in Bulawayo, Zimbabwe. The study forms part of a series of seven studies, commissioned by the International Initiative for Impact Evaluation (3ie), that investigate ways to increase the demand for VMMC in sub-Saharan Africa (see Related Summaries below). In late 2013, 3ie awarded grants to seven project teams of implementers and researchers to pilot innovative programmes for increasing VMMC demand and to conduct rapid impact evaluations of those programmes.
The following is an excerpt from the summary section of this report:
“MTC+ consists of a 60-minute soccer-themed educational session led by a trained ‘coach’, who was circumcised; information, education, and communication material on male circumcision; referrals and phone-based follow-up to interested participants conducted by the coaches; and soccer-based incentives to participants who completed VMMC. This study’s objective was to determine if the MTC+ intervention could substantially and significantly increase demand for VMMC in secondary schools and whether the intervention is an effective, innovative and scalable solution to increasing uptake of VMMC.
This study’s objective was to determine if the MTC+ intervention could substantially and significantly increase demand for VMMC in secondary schools and whether the intervention is an effective, innovative and scalable solution to increasing uptake of VMMC. The study was constructed as a cluster-randomised trial to assess the effectiveness of MTC+. Twenty-six schools in Bulawayo were randomised to receive MTC+ at the start of a four-month trial (intervention) or at the end (control). VMMC uptake over four months was measured via cross-linkage of the trial participant database (n=1, 226 male participants aged 14 to 20 years; median age 16.2) and clinic registers of Bulawayo’s two free VMMC clinics (n=5, 713) from 7 March to 6 July 2014, using eight identifying variables. The trial had more than 80 per cent power to detect an absolute difference of 5 percentage points in VMMC uptake.
A process evaluation was conducted to explore perceptions of VMMC, perceptions and acceptability of the MTC+ intervention, influential factors in deciding whether to undergo VMMC and the role of small incentives in creating demand for VMMC. The process evaluation included 20 in-depth interviews with participants, 10 in-depth interviews with coaches and observation of programme implementation.
The study provides strong evidence of the effectiveness (and cost effectiveness) of MTC+ in Bulawayo secondary schools. Amongst all participants, there is strong evidence that the MTC+ intervention increased VMMC uptake by approximately 2.5-fold (odds ratio [OR]=2.53,95 per cent confidence interval [CI]=1.21–5.30). Restricting the analysis to participants who did not report being circumcised at baseline, the findings suggest that MTC+ increased VMMC uptake by approximately 7.6 percentage points (12.2 per cent vs. 4.6 per cent, OR=2.65, 95 per cent CI=1.19-5.86). These findings are consistent across three levels of sensitivity analysis. The number needed to treat to yield one additional VMMC patient was 13.2 participants not already circumcised at the time of intervention. This translates to about US$49 per new VMMC. Preliminary qualitative findings suggest that MTC+ coaches generally enjoyed and accepted the intervention. Logistical reinforcement from coaches, in the form of follow-up calls and accompaniment to the clinic were important in participants’ decisions to undergo VMMC.
Given the urgent need to increase uptake of VMMC in Zimbabwe and other countries with generalised HIV epidemics and low male circumcision prevalence, it is crucial to take effective interventions to scale in order to prevent new, unnecessary infections. The trial was carried out in a single city, so the results should be treated with cautious optimism when considering the potential impact at scale. Nevertheless, if its effectiveness remains consistent at scale, MTC+could generate substantial new VMMC demand among adolescent males if scaled up in schools, and should be included in a package of effective demand-creation tools.”
3ie website on January 26 2017.