MCUTS Trial: A sport-based intervention to increase uptake of voluntary medical male circumcision among adult male football players: results from a cluster- randomised trial in Bulawayo, Zimbabwe

Background VMMC in Zimbabwe* National target: 80% VMMC coverage by 2015 HIV-negative men aged years Could avert 570,000 (42%) new HIV infections by 2025 Roughly 1 infection averted per 4 VMMCs Sport-based HIV prevention** Strong effects on knowledge, attitudes, behaviour Overall, low-quality studies conducted to date Few studies assessing effects on HIV service uptake GRS conducting two RCTs, planning others * Njeuhmeli (2012) ** Kaufman, Spencer and Ross (2013) in AIDS and Behavior

‘Make The Cut’ Intervention Short, scalable, soccer-based intervention 60 min session facilitated by circumcised men with soccer teams Most men play and watch soccer Logistical and behavioural reinforcement Transport provided Biweekly SMS reminders Priority status at clinic

MCUTS Trial: Methods Soccer teams randomised into three groups Delivery by soccer pros (n=15) Delivery by non-soccer-pros (n=14) Control group (n=18) Primary outcome: VMMC uptake over 4 months Clinic register and consent form Linkage via national ID, name, DOB, age, phone number Baseline surveys using Open Data Kit Assessing reported MC prevalence, knowledge, intentions

MCUTS Trial: Methods

Round 1Round 2Round 3 MCUTS Trial: Results Roughly 9.8-times higher odds of VMMC uptake in intervention than control group: OR=9.81, 95% CI= , p=0.057 Comparing uptake of VMMC between groups, main outcome analysis by intention-to-treat

Round 1Round 2Round 3 MCUTS Trial: Results Hints of difference of effectiveness by age Lower uptake among men over 30 years Comparing VMMC uptake between study groups across age

Round 1Round 2 MCUTS Trial: Discussion Weak evidence of strong relative effect and modest absolute effect Smaller sample size than anticipated  Less statistical power than planned Limited generalizability beyond soccer players MCUTS II with adolescent males and Weekend Special with adult males

Acknowledgements MCUTS Collaborators Zak Kaufman, David Ross, Jeff DeCelles, Kenneth Bhauti, Karin Hatzold, Cynthia Chaibva, & Fennie Mantula Advisor Thomas Clark Implementation Staff Grassroot Soccer Zimbabwe & PSI Zimbabwe Funding Bill & Melinda Gates Foundation Doris Duke Charitable Foundation