Background: Although Zambia has seen an increase in VMMC since 2009, targets have not been achieved hence need for innovative demand creation methodologies including use of market research and human centred design (HCD). These methods should target the most impactful ages (15-29 years) and shorten the journey to circumcision. Utilizing findings from a 2014 journey mapping study conducted in Zambia, Society for Family Health (SFH) employed HCD strategies to analyse and translate findings into demand creation solutions. The process prioritized four of seven identified segments of men, created robust archetypes, and uncovered insights used to inform tailored messages and prototypes for new VMMC demand creation tools to be piloted for effectiveness, efficiency and usability.
Methods: A non-randomized implementation pilot was conducted in eight SFH supported public facilities in four districts. Twenty-three Community Health Workers (CHWs) (13 male, 10 female) and eight supervising CHWs were selected and trained on new messaging and tools. A similar number of CHWs continued to utilize standard demand creation methods in the same facilities.
CHWs conducted door-to-door mobilization activities using new tools and potential clients were classified into a specific segment, exposed to tailored messaging and tools, and recorded in the daily activity report (DAR). Clients interested in getting circumcised were scheduled for an appointment and provided with a referral card. Clients who missed appointments were followed-up a maximum of three times by the CHW.
Results: Overall conversion rate (circumcisions/appointments) was 43% (1,461/3,421) during pilot compared to 35% (884/2,532) for standard methods. Conversion rate was higher amongst priority segments at 45% compared to 39% in non-priority segments. 68% of those circumcised were aged 15-29 years in both methods. On average, men took 42 days from first contact to circumcision. Younger CHWs were more effective whilst female CHWs'' conversion rate was 47% compared to 38% for male CHWs.
Conclusions: The use of segmentation to provide tailored messages and tools is as effective as established demand creation methods and has potential to improve and revolutionize approaches to demand creation for VMMC. Emphasis should be placed on mapping the cascade to VMMC and shortening a man''s journey to circumcision.

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