Moderate/severe adverse events observed overall and 2 and 7 days post-circumcision among N = 427 HIV-uninfected, sexually-active adult men surgically circumcised within the National Safe Male Circumcision program in Gaborone, Botswana.

<p>Moderate/severe adverse events observed overall and 2 and 7 days post-circumcision among N = 427 HIV-uninfected, sexually-active adult men surgically circumcised within the National Safe Male Circumcision program in Gaborone, Botswana.</p

Satisfaction with circumcision procedure and follow-up at 2 and 7 days post-circumcision among HIV-uninfected, sexually-active adult men circumcised within the National Safe Male Circumcision program in Gaborone, Botswana.

<p>Satisfaction with circumcision procedure and follow-up at 2 and 7 days post-circumcision among HIV-uninfected, sexually-active adult men circumcised within the National Safe Male Circumcision program in Gaborone, Botswana.</p

Flow chart of N = 577 men screened for circumcision eligibility within the National Safe Male Circumcision program in Gaborone, Botswana.

<p>Two participants did not meet two eligibility criteria and thus the number and percentages presented for individual reasons for ineligibility sum to >100%.</p

Map of selected communities and stratified sampling schema of focus discussion groups among men, women and community leaders according to age and circumcision status, Botswana, July to November 2013.

<p>Map of selected communities and stratified sampling schema of focus discussion groups among men, women and community leaders according to age and circumcision status, Botswana, July to November 2013.</p

Current responses at multiple levels of intervention to address the social contextual factors impacting HIV prevention.

<p>Current responses at multiple levels of intervention to address the social contextual factors impacting HIV prevention.</p

Number of participants in Interviews, Focus Groups and Assessments, by place and type.

<p>Number of participants in Interviews, Focus Groups and Assessments, by place and type.</p

Characteristics of Study Sites.

†<p>Stats SA 2011 Community Survey <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0102904#pone.0102904-StatsSA1" target="_blank">[74]</a>.</p><p>*StatsSA. 2007 Community Survey - Labor Force <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0102904#pone.0102904-StatsSA2" target="_blank">[75]</a>.</p><p>**Department of Health.2011. The National Antenatal Sentinel HIV and Syphilis Prevalence Survey <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0102904#pone.0102904-National1" target="_blank">[19]</a>.</p

Is it all about the money? A qualitative exploration of the effects of performance-based financial incentives on Zimbabwe's voluntary male medical circumcision program

<div><p>Background</p><p>In 2013, Zimbabwe’s voluntary medical male circumcision (VMMC) program adopted performance-based financing (PBF) to speed progress towards ambitious VMMC targets. The $25 USD PBF intended to encourage low-paid healthcare workers to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports healthcare workers (HCWs) who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels.</p><p>Methods</p><p>This qualitative study assessed the effect of the PBF on HCW motivation, satisfaction, and professional relationships. The study objectives were to: 1) Gain understanding of the advantages and disadvantages of PBF at the HCW level; 2) Gain understanding of the advantages and disadvantages of PBF at the site level; and 3) Inform scale up, modification, or discontinuation of PBF for the national VMMC program. Sixteen focus groups were conducted: eight with HCWs who received PBF for VMMC and eight with HCWs in the same clinics who did not work in VMMC and, therefore, did not receive PBF. Fourteen key informant interviews ascertained administrator opinion.</p><p>Results</p><p>Findings suggest that PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace, creating divisiveness that may reach beyond VMMC. PBF may also cause distortion in the healthcare system: HCWs prioritized incentivized VMMC services over other routine duties. To reduce workplace tension and improve the VMMC program, participants suggested increasing HCW training in VMMC to expand PBF beneficiaries and strengthening integration of VMMC services into routine care.</p><p>Conclusion</p><p>In the low-resource, short-staffed context of Zimbabwe, PBF enabled rapid VMMC scale up and achievement of ambitious targets; however, side effects make PBF less advantageous and sustainable than envisioned. Careful consideration is warranted in choosing whether, and how, to implement PBF to prioritize a public health program.</p></div

MOHCC fee for service structure, 2015, and average HCW salary.

<p>MOHCC fee for service structure, 2015, and average HCW salary.</p

Patient Characteristics (Categorical Variables).

<p>AZT = zidovudine, 3TC = lamivudine, EFV = efavirenz, NVP = nevirapine.</p><p>Chi-square test p-values for difference in failure proportions by group, among patients included in the primary analysis:^ap<.05,</p>b<p>p<0.01.</p><p>Patient Characteristics (Categorical Variables).</p