Evaluation of Four Interventions Using Behavioral Economics Insights to Increase Demand for Voluntary Medical Male Circumcision in South Africa Through the MoyaApp: A Quasi-Experimental Study.

Background: While voluntary medical male circumcision (VMMC) reduces the risk of HIV transmission by 60%, circumcision coverage falls short of the UNAIDS 90% VMMC target. We investigated whether behaviorally informed message framing increased demand for VMMC.

Setting: Adult users of the MoyaApp, a data-free application in South Africa, who viewed a form designed to generate interest in VMMC from August 2022 to November 2022.

Methods: A quasi-experimental study was conducted to evaluate 4 MoyaApp VMMC intervention forms against the standard-of-care (SOC) form. All forms enabled users to provide contact details for follow-up engagement by a call center. The primary outcome was the proportion of forms submitted. Secondary outcomes included successful contact with the user, VMMC bookings/referrals, and confirmed circumcision. Multivariable ordinary least-squares regression was used for the analysis.

Results: Of 118,337 MoyaApp VMMC form viewers, 6% submitted a form. foot-in-the-door form viewers were more likely (+1.3 percentage points, P < 0.01) to submit a form compared with the SOC group (6.3%). Active Choice (-1.1 percentage points, P < 0.01) and Reserved for You (-0.05 percentage points, P < 0.05) form viewers were less likely to submit a form compared with SOC form. Users submitting the foot-in-the-door form were less likely to be booked/referred compared with those using the SOC form (-5 percentage points, P < 0.05). There were no differences between the intervention and SOC forms for successful contact and circumcisions.

Conclusions: Message framing using behavioral insights was able to nudge men to engage with VMMC services. However, more work is needed to understand how to convert initial interest into bookings and circumcisions.