Thirumurthy Harsha, Masters Samuel H, Rao Samwel, Murray Kate, Prasad Ram, Zivin Joshua G, Omanga Eunice, Agot Kawango
*Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; †Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; ‡Impact Research and Development Organization, Kisumu, Kenya; §Final Mile, Mumbai, India; and ‖University of California San Diego, San Diego, CA.
J Acquir Immune Defic Syndr. 2016 Aug 15;72 Suppl 4(Suppl 4):S299-305. doi: 10.1097/QAI.0000000000001045.
Effective demand creation strategies are needed to increase uptake of medical male circumcision and reduce new HIV infections in eastern and southern Africa. Building on insights from behavioral economics, we assessed whether providing compensation for opportunity costs of time or lottery-based rewards can increase male circumcision uptake in Kenya.
Uncircumcised men aged 21-39 years were randomized in 1:1:1 ratio to 2 intervention groups or a control group. One intervention group was offered compensation of US $12.50 conditional on circumcision uptake. Compensation was provided in the form of food vouchers. A second intervention group was offered the opportunity to participate in a lottery with high-value prizes on undergoing circumcision. The primary outcome was circumcision uptake within 3 months.
Among 903 participants enrolled, the group that received compensation of US $12.50 had the highest circumcision uptake (8.4%, 26/308), followed by the lottery-based rewards group (3.3%, 10/302), and the control group (1.3%, 4/299). Logistic regression analysis showed that compared with the control group, the fixed compensation group had significantly higher circumcision uptake [adjusted odds ratio 7.1; 95% CI: 2.4 to 20.8]. The lottery-based rewards group did not have significantly higher circumcision uptake than the control group (adjusted odds ratio 2.5; 95% CI: 0.8 to 8.1).
Providing compensation was effective in increasing circumcision uptake among men over a short period. The results are consistent with studies showing that such interventions can modify health behaviors by addressing economic barriers and behavioral biases in decision making. Contrary to findings from studies of other health behaviors, lottery-based rewards did not significantly increase circumcision uptake.
Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107.
需要有效的需求创造策略来提高男性包皮环切术的接受率，并减少东非和南部非洲的新增艾滋病毒感染病例。基于行为经济学的见解，我们评估了为时间机会成本提供补偿或基于抽奖的奖励是否能提高肯尼亚男性包皮环切术的接受率。
将年龄在21至39岁之间的未行包皮环切术的男性按1:1:1的比例随机分为2个干预组或1个对照组。一个干预组在接受包皮环切术后可获得12.50美元的补偿。补偿以食品券的形式提供。第二个干预组有机会在接受包皮环切术后参加有高额奖品的抽奖。主要结局是3个月内的包皮环切术接受率。
在903名登记参与者中，获得12.50美元补偿的组包皮环切术接受率最高（8.4%，26/308），其次是基于抽奖奖励的组（3.3%，10/302），对照组为（1.3%，4/299）。逻辑回归分析显示，与对照组相比，固定补偿组的包皮环切术接受率显著更高[调整优势比7.1；95%置信区间：2.4至20.8]。基于抽奖奖励的组的包皮环切术接受率与对照组相比没有显著更高（调整优势比2.5；95%置信区间：0.8至8.1）。
提供补偿在短期内有效地提高了男性的包皮环切术接受率。这些结果与研究表明此类干预措施可通过解决经济障碍和决策中的行为偏差来改变健康行为的研究一致。与其他健康行为研究的结果相反，基于抽奖的奖励并没有显著提高包皮环切术的接受率。
国际发展影响评估登记处：RIDIE - STUDY - ID - 530e60df56107
