The Effects of Providing Fixed Compensation and Lottery-Based Rewards on Uptake of Medical Male Circumcision in Kenya

Harsha Thirumurthy, Samuel H Masters, Samwel Rao, Kate Murray, Ram Prasad, Joshua Graff Zivin, Eunice Omanga and Kawango Agot

University of California at San Diego, Economics Working Paper Series from Department of Economics, UC San Diego

Abstract: Background 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. Methods 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. Results 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). Conclusions 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. Trial registration Registry for International Development Impact Evaluations: RIDIE-STUDY-ID-530e60df56107.

Keywords: Behavioral and Social Science; Prevention; Mental Health; HIV/AIDS; Clinical Trials and Supportive Activities; Clinical Research; Adult; Circumcision; Male; Compensation and Redress; Humans; Kenya; Male; Reward; Young Adult; male circumcision; demand creation; economic interventions; lottery-based rewards; behavioral economics; Clinical Sciences; Public Health and Health Services; Virology (search for similar items in EconPapers)
Date: 2016-10-01
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Citations: View citations in EconPapers (5)

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