Strength of Evidence on Demand Creation for Voluntary Medical Male Circumcision From 7 Impact Evaluations in Southern and Eastern Africa

Background: Seven new impact evaluations of pilot programs for increasing the demand for voluntary medical male circumcision (VMMC) provide evidence of what works and what does not. The study findings suggest that financial compensation designed to relieve the opportunity or transportation costs from undergoing the procedure can increase the uptake of VMMC. There is also evidence that programs using peer influence can be effective, although so far only sports-based programs demonstrate a strong effect. We explore the strength of evidence in each of these 7 studies to better interpret the findings for policy making. Methods: We perform a risk of bias assessment and conduct power calculations using actual values for each of the 7 studies. Results: Three of the 7 studies have a medium risk of bias, whereas the other 4 have a low risk of bias. All but 2 of the studies have adequate power to detect meaningful effects. In the 2 with insufficient power, the estimated effects are large but statistically insignificant. Conclusion: The positive evidence that financial incentives presented as compensation for opportunity costs to men seeking and obtaining VMMC can increase uptake comes from strong studies, which have high power and low to medium risk of bias. The positive evidence that a comprehensive sports-based program for young men can increase uptake also comes from a strong study. The strength of the studies further validates these findings.