Background: WHO recommends a male circumcision (MC) prevalence higher than 80% to have a substantial impact on the HIV-AIDS epidemic in Eastern and Southern Africa. The objective of the study was to assess whether a novel intervention can lead to a high voluntary male medical circumcision (VMMC) uptake among adults in a short time.
Methods: This prospective observational intervention study was conducted in the township of Orange Farm (South Africa). In this semi-urban area MC prevalence among adults aged 18-49 years was stable between 2010 and 2015 at 55%-57%, despite regular VMMC campaigns at community level, and the presence of a VMMC clinic that offered free VMMC.
The intervention took place in a random sample of 983 households where 512 men aged 18-49 years were identified. Among the 226 uncircumcised men, 212 accepted to be enrolled in the intervention study. At household level the intervention consisted of a discussion with the members. A personal MC adviser trained on interpersonal communication skills was assigned to each uncircumcised participant. The MC advisers were trained to explain the risks and benefits of VMMC and to discuss 24 possible reasons given by men for not being circumcised. Participants where followed up for 9 weeks. Each participant had a maximum of 3 motivational talks at home. Participants who decided to be circumcised received time compensation in cash equivalent to 2.5 days of work at the minimum South African salary rate.
Results: Among the 212 uncircumcised men, 69.3% (147/212; 95%CI; 62.9% to 75.3%) agreed to be circumcised, which corresponds to the uptake. The MC prevalence of the sample increased from 56.9% (296/522) to 84.9% (443/522; 81.6% to 87.7%), p< 0.001. The reported reasons for accepting circumcision were motivational talks with the MC adviser (83.0%), and time compensation (40.0%).
Conclusions: High VMMC uptake can be obtained in a short time among male adults but requires an intense intervention centred on uncircumcised men at an individual level and time compensation. The effect of this novel intervention should now be tested elsewhere.