An implementation science study investigating profiles of men interested in medical male circumcision (MMC), barriers and methods to increase the uptake of MMC among older men in South Africa (IMBIZO)

标题：评估有条件现金转移对增加医疗男性吸纳的影响 南非男性的割礼。 项目的PI 玛丽·H·拉特卡，博士每小时 其他关键人员 加文·J·丘奇亚德 姆福·马拉萨内 吉莉安·格雷萨克 凯瑟琳·菲尔丁 摘要/项目摘要 这项实施科学研究的目的是评估提供人力资源的影响 年龄20-49岁，有金钱动机接受医学男性包皮环切术(MC) 领悟。MC可将男性感染艾滋病毒的风险降低约60%。在全球范围内，推出 在艾滋病毒高流行率和低MC的国家，MC在成年男性中得到优先考虑 流行率。尽管为这一程序提供了大量、高质量的服务，但对 MC不能得到保证。有条件现金转移(CCT)计划涉及支付定义的 现金是指实施增进健康的服务或行为的人。有条件现金转移支付方案 在拉丁美洲被广泛使用，但在非洲还没有。在MC上测试CCT方法 我们将在我们由PEPFAR资助的MC诊所进行为期两年的实施科学 在南非约翰内斯堡的Ekurhuleni北区。首先我们将进行一次试点 研究将在哪里确定要测试的现金转移金额。然后我们将进行一次审判 其中有4488名年龄在20-49岁的男性在服务外展过程中遇到感兴趣的 MC将同意随机选择两种可能的现金转账金额之一(1122 每个)，或涉及接收标称物品(即水瓶/水盖)的控制条件(2244)。 所有男性，无论处于随机状态，都可以免费使用我们的MC服务。至 衡量有效性，我们将比较MC收益率(MC的数值除以 已交付凭证)，用于控制条件下具有收益率的每个现金转账金额。我们有 90%的统计能力，即使在最坏的情况下关于MC摄取的控制和 干预条件。为了描述对激励做出反应的男性，我们将衡量社会- 来MC的男性的人口统计、文化信仰、艾滋病毒风险概况和艾滋病毒状况，以及 比较现金转移武器和控制之间的这些特征。评估任何可能的 这项计划对年龄范围内的男性的不良影响，我们将测量MC 18-19岁男性在干预期之前、期间和之后的摄取情况。至 确定可能会抑制或促进MC随后将CCT转移到 其他背景，包括文化信仰和传统，我们将与 在试验前和试验期间参与MC服务提供的外展和诊所工作人员，结果 这项研究将对MC的推出具有及时和直接的相关性。如果有条件现金 转移在增加成年男性需求方面是有效的，这种方法可以推广 为了加快在南部非洲的MC吸收，那里需要快速吸收才能实现人口- 水平影响。

Title: Evaluating the impact of conditional cash transfers to increase uptake of medical male circumcision among South African men. PI of the project Mary H. Latka, PhD MPH Other Key Personnel Gavin J. Churchyard Mpho Maraisane Gillian Gresak Katherine Fielding Abstract/ Project Summary The purpose of this implementation science study is to evaluate the impact of providing men aged 20-49 with a monetary incentive to undergo medical male circumcision (MC) on MC uptake. MC reduces men's risk of HIV acquisition by approximately 60%. Globally, roll out of MC is being prioritized among adult men in countries with high HIV prevalence and low MC prevalence. Despite high volume, high quality services available for this procedure, demand for MC is not guaranteed. Conditional cash transfer (CCT) programmes involve paying a defined cash amount to persons who enact a health-enhancing service or behaviour. CCT programmes have been used extensively in Latin America, but not Africa. To test the CCT approach on MC uptake, we will conduct two years of implementation science at our PEPFAR-funded MC clinic in the Ekurhuleni North sub-district of Johannesburg, South Africa. First we will conduct a pilot study where the cash transfer amounts to be tested will be identified. We will then conduct a trial where 4488 men aged 20-49 encountered during service delivery outreach who are interested in MC will give their consent to be randomized to one of two possible cash transfer amounts(1122 each), or a control condition (2244) involving receipt of a nominal item (i.e. water bottle/cap). All men, regardless of randomization status, will be able to access our MC service for free. To measure effectiveness, we will compare the MC yield (number in for MC over the number of vouchers delivered) for each cash transfer amount with yield in the control condition. We have >90% statistical power, even under worst case assumptions about MC uptake in the control and intervention conditions. To describe men who respond to incentives we will measure the socio- demographics, cultural beliefs, HIV risk profile and HIV status of men who come in for MC, and compare these characteristics between cash transfer arms and control. To evaluate any possible untoward effect of this programme on men just short of the age range, we will measure MC uptake among men aged 18-19 immediately before, during and after the intervention period. To identify perceptions that may inhibit or facilitate the subsequent transfer of a CCT for MC to other settings, including cultural beliefs and traditions, we will conduct focus groups with outreach and clinic staff involved in MC service delivery before and during the trial, Findings from this research will have timely and direct relevance to MC roll-out. If conditional cash transfers are effective in increasing demand among adult men, this approach could be expanded to hasten the uptake MC in Southern Africa where rapid uptake is needed to achieve population- level impacts.