Background: In 2010, the South African government introduced voluntary medical male circumcision (VMMC) as part of its national HIV prevention policy - to achieve a targeted 4.3 million circumcisions by the end of 2016. In their strategy to help government reach this target, the SACTWU Worker Health Programme (SWHP) offered VMMC as one of their free services. This is done at their clinics, mobile clinics, and government health care facilities. To improve VMMC uptake, innovative and effective approaches are needed. The objective of this pilot study was to examine the efficacy of using a free Unstructured Supplementary Service Data (USSD) number on their mobiles to book VMMC services.
Methods: Using behavioural economics, SWHP developed a demand creation campaign to boost the uptake of VMMC services among 18 - 35 years old males. Booking an appointment was made easier by dialing the number, *134*450# for free. Men would follow a few simple steps to make an appointment at a convenient date at a health care facility. This booking is followed by a confirmation SMS and a reminder SMS a day before the appointment. This data was used to predict and meet demand in areas where it was most needed. This study was piloted in three of the nine South African provinces: KwaZulu-Natal, Free State and Western Cape. The efficacy of this system was assessed at two months.
Results: From October to December 2016, 48 525 persons accessed the USSD number. A total of 11 533 (24%) were circumcised. The average age of the participants was 18. Most males (74%) were circumcised at clinics, followed by circumcision camps (26%). The most circumcisions took place in KwaZulu-Natal (80%), followed by the Free State (10%) and Western Cape (9%).
Conclusions: Our findings suggest that the integration of a nudge in the form of a carefully designed free USSD booking system into SWHP VMMC demand creation interventions was a success. Our results are also consistent with behavioural economics studies showing that small nudges can modify health behaviours. The effect of this novel intervention should now be tested on a broader scale and in different contexts.

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