Voluntary Medical Male Circumcision: Matching Demand and Supply with Quality and Efficiency in a High-Volume Campaign in Iringa Region, Tanzania

Hally Mahler and colleagues evaluate a six-week voluntary medical male circumcision campaign in Iringa province of Tanzania, providing a model for matching supply with demand for services and showing that high-volume circumcisions can be performed without compromising client safety

Use of Lotteries for the Promotion of Voluntary Medical Male Circumcision Service: A Discrete-Choice Experiment among Adult Men in Tanzania.

Voluntary medical male circumcision (VMMC) is effective in reducing the risk of human immunodeficiency virus (HIV). However, countries like Tanzania have high HIV prevalence but low uptake of VMMC. We conducted a discrete-choice experiment to evaluate the preferences for VMMC service attributes in a random sample of 325 men aged 18 years or older from the general population in 2 Tanzanian districts, Njombe and Tabora. We examined the preference for financial incentives in the form of a lottery ticket or receiving a guaranteed transport voucher for attendance at a VMMC service. We created a random-parameters logit model to account for individual preference heterogeneity and a latent class analysis model for identifying groups of men with similar preferences to test the hypothesis that men who reported sexually risky behaviors (i.e., multiple partners and any condomless sex in the past 12 months) may have a preference for participation in a lottery-based incentive. Most men preferred a transport voucher (84%) over a lottery ticket. We also found that offering a lottery-based financial incentive may not differentially attract those with greater sexual risk. Our study highlights the importance of gathering local data to understand preference heterogeneity, particularly regarding assumptions around risk behaviors

Postoperative return rates two and seven days after surgery.

<p>Postoperative return rates two and seven days after surgery.</p

The layout of Ngome Health Centre.

<p>Before the campaign, this space was empty, having been built but not yet configured to function as a reproductive health facility. The Iringa Region team adapted the space for efficient VMMC service delivery by expanding the number of surgical bays (eight beds to accommodate two surgical teams), providing a large space for decontamination, increasing the number of individual counseling areas (including a tent to accommodate additional counselors), and including a separate postoperative area.</p

Age distribution of VMMC clients.

<p>Age distribution of VMMC clients.</p

VMMCs performed during the campaign, by site.

a<p>Catchment area defined as within 15 km of the facility.</p>b<p>With extra nurse.</p

HIV testing, by age group.

<p>HIV testing, by age group.</p