Employing Demand-Based Volumetric Forecasting to Identify Potential for and Roles of Devices in Scale-Up of Medical Male Circumcision in Zambia and Zimbabwe

Introduction: Devices for male circumcision (MC) are becoming available in 14 priority countries where MC is being implemented for HIV prevention. Understanding potential impact on demand for services is one important programmatic consideration because countries determine whether to scale up devices within MC programs. Methods: A population-based survey measuring willingness to undergo MC, assuming availability of surgical MC and 3 devices, was conducted among 1250 uncircumcised men, ages 10–49 years in Zambia and 1000 uncircumcised men, ages 13–49 years in Zimbabwe. Simulated Test Market methodology was used to estimate incremental MC demand and the extent to which devices might be preferred over surgery, assuming availability of: surgical MC in both countries; the devices PrePex, ShangRing, and Unicirc in Zambia; and PrePex in Zimbabwe. Results: Modeled estimates indicate PrePex has the potential to provide an overall increase in MC demand ranging from an estimated 13%–50%, depending on country and WHO prequalification ages, replacing 11%–41% of surgical procedures. In Zambia, ShangRing could provide 8% overall increase, replacing 45% of surgical procedures, and Unicirc could provide 30% overall increase, replacing 85% of surgical procedures. Conclusions: In both countries, devices have potential to increase overall demand for MC, assuming wide scale awareness and availability of circumcision by the devices. With consideration for age and country, PrePex may provide the greatest potential increase in demand, followed by Unicirc (measured in Zambia only) and ShangRing (also Zambia only). These results inform one program dimension for decision making on potential device introduction strategies; however, they must be considered within the broader programmatic context

A case study for a psychographic-behavioral segmentation approach for targeted demand generation in voluntary medical male circumcision

Public health programs are starting to recognize the need to move beyond a one-size-fits-all approach in demand generation, and instead tailor interventions to the heterogeneity underlying human decision making. Currently, however, there is a lack of methods to enable such targeting. We describe a novel hybrid behavioral-psychographic segmentation approach to segment stakeholders on potential barriers to a target behavior. We then apply the method in a case study of demand generation for voluntary medical male circumcision (VMMC) among 15–29 year-old males in Zambia and Zimbabwe. Canonical correlations and hierarchical clustering techniques were applied on representative samples of men in each country who were differentiated by their underlying reasons for their propensity to get circumcised. We characterized six distinct segments of men in Zimbabwe, and seven segments in Zambia, according to their needs, perceptions, attitudes and behaviors towards VMMC, thus highlighting distinct reasons for a failure to engage in the desired behavior

VMMC scale-up scenarios evaluated.

<p>VMMC scale-up scenarios evaluated.</p

Projected impact of the VMMC program over 2016–2030, with VMMC scale-up embedded within broader scale-up of HIV prevention and treatment, according to the global Fast Track targets, evaluated relative to the counterfactual scenario in which the Fast Track targets for other interventions are met without VMMC.

<p>Projected impact of the VMMC program over 2016–2030, with VMMC scale-up embedded within broader scale-up of HIV prevention and treatment, according to the global Fast Track targets, evaluated relative to the counterfactual scenario in which the Fast Track targets for other interventions are met without VMMC.</p

Sensitivity analyses.

<p>Impact and cost-effectiveness of Zimbabwe’s VMMC program under alternative assumptions for key parameters whose values are uncertain.</p

Modeled circumcisions.

<p><b>(A) Number of new VMMCs occurring each year and (B) the resulting percentage of men ages 15–49 who are circumcised, by scenario.</b> The 2009–2016 new VMMCs are from program data; the 2008–2009 circumcision coverage was the modelers’ estimate based on the 2005 and 2010 DHS. The projected results (VMMC numbers and circumcision coverage over 2010–2030) shown here are from the Goals model; the ICL and EMOD models projected similar numbers (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0199453#pone.0199453.t002" target="_blank">Table 2</a>) and coverages (not shown).</p

Projected impact, costs and savings from the VMMC program in a 'status quo' background context, relative to the counterfactual scenario of no VMMC program ever.

<p>Projected impact, costs and savings from the VMMC program in a 'status quo' background context, relative to the counterfactual scenario of no VMMC program ever.</p