Cluster randomized controlled trial of SKILLZ to increase voluntary medical male circumcision among adolescent male students in Zimbabwe

DETAILED SUMMARY

Importance

• Voluntary medical male circumcision (VMMC) has been shown to reduce female-to-male HIV transmission by 50-60%, but progress toward coverage targets in priority countries like Zimbabwe was low at the time of this study. Sports-based interventions offer a promising platform to promote HIV prevention and VMMC among young men.

Objective

• To evaluate whether the Make the Cut-Plus football-based intervention increases VMMC knowledge and uptake among secondary male students in Bulayo, Zimbabwe, over 3 months.

Study details

• Study design: Cluster randomized control trial
• Data collection tools: Pre-, post-, and follow-up questionnaires, clinic registers
• Participants: 1,567 male students from 26 schools making up one intervention group and one control group (13 schools in each group, schools serving as unit of randomization); age range: 14–20 years; median age of 16.2 years 
• Implementation setting: 26 secondary schools in Bulayo, Zimbabwe
• Study period: The intervention was delivered over a period of 3 months (March 2014 to June 2014). There was a 3 month follow up.

Intervention

• Make the Cut +: 60-minute session delivered in schools by a trained Coach. Coaches followed up with participants via SMS, Whatsapp, or phone to coordinate trips to clinics for VMMC appointments, with transport provided.

Results

• 1,226 total participants–399 (70.6%) intervention and 479 (72.5%) control participants– completed the endline questionnaires.
• Average correct responses on health knowledge assessments increased from 61% to 83% in the intervention group, while the control group showed minimal change (62% to 65%) (p<0.001).
• VMMC uptake among eligible boys in the intervention group increased by 18% compared to the control group (p < 0.05), suggesting enhanced awareness and motivation to engage in HIV-preventive behaviors.
• Coaches in the intervention group also demonstrated improved health knowledge (from 76% to 93%, p < 0.001), while control coaches showed no significant change.
• Both groups rated their training highly, though intervention coaches reported higher satisfaction and perceived program impact.

Conclusions and implications

• The MTC+ trial demonstrates that a school-based, soccer-themed intervention can be successfully implemented in Zimbabwean schools and lead to substantial increases in VMMC uptake among adolescent males.