International Journal of Advanced Research and Publications ISSN: 2456-9992 Volume 1 Issue 5, November 2017 www.ijarp.org 419 Conditional Cash Transfers To Promote Male Circumcision Uptake In Middle And Low Income Countries: Review Jacques Lukenze Tamuzi , Jonathan Lukusa Tshimwanga , Ley Muyaya Muyaya , Esperance Musanda Manwana Community Health Division, Faculty of Medicine and Health Sciences, Stellenbosch University, Matieland, South Africa Division of Family medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Matieland, South Africa E-mail: drjacques.tamuzi@gmail.com Abstract: 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.int/trialsearch/). 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 95%CI 4.17 to 5.48, 6286 participants, 6 studies, P< 0.00001). Heterogeneity: Chi² = 8.97, df = 5 (P = 0.11); I² = 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. Key words: VMMC; conditional cash transfer; HIV Background Description of the condition Despite access to safe voluntary medical male circumcision (VMMC) and the proof of its effectiveness in reducing acquisition of HIV and other sexually transmitted infections, uptake remains suboptimal in many countries in sub-Saharan Africa(SSA) (Lilleston 2017). VMMC provides direct protection against male HIV acquisition by removing the foreskin which is rich in HIV target cells (Donoval 2006; Kigozi 2009; Lilleston 2017). The potential effect of VMMC on population-level HIV incidence depends on this biologic effect, the level of VMMC coverage, risk profiles of men accepting VMMC, and whether behavioral disinhibition occurs following circumcision (Lilleston 2017). VMMC reduces female-to-male HIV transmission by approximately 60% (Weiss 2000; Bailey 2007; Bazant 2016) and is a recommended HIV prevention strategy in countries with high HIV prevalence and low levels of male circumcision (Bazant 2016). 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 Lesotho, Malawi, South Africa, and Uganda (Kripke 2016). In the first (90-90- 90) scenario, combined scale-up of ART and VMMC affords greater reductions in HIV incidence than would be achieved by ART scale-up alone in all four countries (Kripke 2016). Mathematical models have estimated that VMMC scale-up across SSA could prevent up to 6 million new HIV infections and 3 million deaths by 2025 (Weiss 2000; Kibira 2017). VMMC has been rolled out in 14 African countries starting in 2009, and WHO estimates that 11.7 million men have been circumcised as of December 2015( Gray 2007; Kibira 2017). Heterosexual transmission of HIV is still the biggest contributor to the HIV epidemic in sub SSA where over 70 % of the estimated global 35 million HIV positive people live (Wanyama 2009; UNAIDS 2014). Male circumcision reduces HIV heterosexual transmission risk from infected women to men, prevalence of high risk human papilloma virus and incidence of Herpes simplex virus two in men and, genital ulcers in female partners of circumcised HIV negative men (Nurminen 1997; Auvert 2009; Kibira 2017). This is the reason why the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) issued guidance urging countries with high HIV prevalence and low male circumcision rates to incorporate voluntary medical male circumcision (VMMC) into their HIV prevention programs (Bailey 2007; Kikaya 2016). When we consider individual interpersonal factors that are influencing VMMC uptake; several barriers among