Conditional Cash Transfers To Promote Male Circumcision Uptake In Middle And Low Income Countries Review

Background Voluntary medical male circumcision VMMC reduces female-to-male HIV transmission by approximately 60 and is a recommended HIV prevention strategy in countries with high HIV prevalence and low levels of male circumcision. Mathematical models have illustrated that VMMC scale-up across Sub-Saharan Africa could prevent up to 6 million new HIV infections and 3 million deaths by 2025. Compared to the epidemic impact of scaling up ART to 90-90-90 levels VMMC scale-up demonstrated additional reductions in HIV incidence and lower long-term annual program costs in models applied to several Sub-Saharan African countries. Therefore low income countries are facing several challenges among which economic factors such as lost wages and opportunity costs of time are likely to be important barriers for VMMC uptake. Conditional cash transfers have shown its efficacy in many studies conducting low and middle countries where economic factors are impacting negatively on VMMC. Objectives to assess the effectiveness of cash transfers to improve voluntary medical male circumcision. Methods We searched eligible studies through each database from January 2017 to April 2017. We used the key words added with Boolean operators to search studies. The following databases were assessed Cochrane Central Register of Controlled Trials CENTRAL MEDLINE PubMed Scopus CINAHL and Web of Science WOS. We also searched ongoing RCTs through ClinicalTrials.gov www.clinicaltrials.gov and World Health Organization WHO International Clinical Trials Registry Platform ICTRP search portal apps.who.inttrialsearch. We included randomized control trials that evaluated the impact of conditional cash transfers on male circumcision. All included studies were selected in low and middle income countries. JT identified studies through different database. JT and LM independently assessed eligible studies that met inclusion criteria. We used the statistical package RevMan 5.3 provided by Cochrane. As heterogeneity among included studies was not important we conducted meta-analysis. We reported the typical if at least two trials were included odds ratio. All values were reported with their 95 CIs. Results the main result has shown that conditional cash transfer was 4.78 times more likely to improve VMMC compared to the control group OR 4.78 95CI 4.17 to 5.48 6286 participants 6 studies P 0.00001. Heterogeneity Chi 8.97 df 5 P 0.11 I 44. The evidence was graded high. Conclusion based on the results we can conclude that conditional cash transfer is beneficial in improving VMMC. The quality of evidence was judged high so this review could play an important role in VMMC policy in middle and low income countries.