Incentivizing HIV/STI Testing: A Systematic Review of the Literature

Lee, Ramon; Cui, Rosa R.; Muessig, Kathryn E.; Thirumurthy, Harsha; Tucker, Joseph D.

doi:10.1007/s10461-013-0588-8

Cited by 85 publications

(78 citation statements)

References 42 publications

(100 reference statements)

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“…21 However, despite growing interest in using incentives to promote HIV-related behaviors such as HIV testing uptake, linkage to HIV care, and retention in care, evidence from randomized trials has been limited. 22–26 This study illustrates the strengths and limitations of using incentives as a strategy for modifying such behaviors and preventing new HIV infections.…”

Section: Discussionmentioning

confidence: 91%

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

Thirumurthy

Masters

Rao

et al. 2014

JAMA

Self Cite

116

133

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IMPORTANCE Novel strategies are needed to increase the uptake of voluntary medical male circumcision (VMMC) in sub-Saharan Africa and enhance the effectiveness of male circumcision as an HIV prevention strategy. OBJECTIVE To determine whether small economic incentives could increase circumcision prevalence by addressing reported economic barriers to VMMC and behavioral factors such as present-biased decision making. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial conducted between June 22, 2013, and February 4, 2014, among 1504 uncircumcised men aged 25 to 49 years in Nyanza region, Kenya. VMMC services were provided free of charge and participants were randomized to 1 of 3 intervention groups or a control group. INTERVENTIONS Participants in the 3 intervention groups received varying amounts of compensation conditional on undergoing circumcision at 1 of 9 study clinics within 2 months of enrollment. Compensation took the form of food vouchers worth 200 Kenya shillings (≈US $2.50), 700 Kenya shillings (≈US $8.75), or 1200 Kenya shillings (≈US $15.00), which reflected a portion of transportation costs and lost wages associated with getting circumcised. The control group received no compensation. MAIN OUTCOMES AND MEASURES VMMC uptake within 2 months. RESULTS Analysis of data for 1502 participants with complete data showed that VMMC uptake within 2 months was higher in the US $8.75 group (6.6%; 95% CI, 4.3%–9.5% [25 of 381]) and the US $15.00 group (9.0%; 95% CI, 6.3%–12.4% [34 of 377]) than in the US $2.50 group (1.9%; 95% CI, 0.8%–3.8% [7 of 374]) and the control group (1.6%; 95% CI, 0.6%–3.5% [6 of 370]). In logistic regression analysis, the US $8.75 group had significantly higher VMMC uptake than the control group (adjusted odds ratio [AOR] 4.3; 95% CI, 1.7–10.7), as did the US $15.00 group (AOR 6.2; 95% CI, 2.6–15.0). Effect sizes for the US $8.75 and US $15.00 groups did not differ significantly (P = .20). CONCLUSIONS AND RELEVANCE Among uncircumcised men in Kenya, compensation in the form of food vouchers worth approximately US $8.75 or US $15.00, compared with lesser or no compensation, resulted in a modest increase in the prevalence of circumcision after 2 months. The effects of more intense promotion or longer implementation require further investigation.

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Section: Discussionmentioning

confidence: 91%

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

Thirumurthy

Masters

Rao

et al. 2014

JAMA

Self Cite

116

133

View full text Add to dashboard Cite

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“…The starting point for all interventions must still be HIV counseling and testing. Innovative ways to promote testing have shown promise including incentivization, self-testing, and mobile health 29,30 but more evaluation to show effectiveness in this age group is required. Comparison of those who tested and those who did not test demonstrated that a higher proportion of those who did not test 36% had less than senior secondary school education compared to 12% for those who tested, suggesting the importance of education on HIV testing.…”

Section: Discussionmentioning

confidence: 99%

Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services

Ramadhani

Ndembi

Nowak

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background and setting As data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited, settings (RLS) are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria. Methods TRUST/RV368 study used respondent-driven-sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every three months (Abuja) or six months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and six-month viral suppression. Results A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed six months and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at six months. Conclusions Social determinants of health potentiated increased HIV Care Continuum outcomes. Integration of HIV prevention, HIV Counselling and Testing services and universal coverage of ART into a community-based clinic is critical in achieving better hig HIV Care Continuum outcomes.

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“…Among youth aged 12–15 years, 12.7% more individuals tested at the youth centre compared to the clinic [22]. A recent systematic review evaluating the effects of incentives on HIV and sexually transmitted infection testing uptake (7 studies of monetary or non-monetary rewards, including 3 studies described above [19–21]) all demonstrated higher uptake in the incentivized groups; the greatest effect was at non clinic-based testing sites [23]. …”

Section: Hiv Testingmentioning

confidence: 99%

Financial incentives to improve progression through the HIV treatment cascade

Bassett

Wilson

Taaffe

et al. 2015

Current Opinion in HIV and AIDS

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Purpose of review We reviewed recent literature on conditional and unconditional financial incentives for their impact on improving movement through the HIV care cascade and HIV prevention. Recent findings Concepts from behavioral economics may help improve engagement in HIV care by addressing upstream structural risk factors for HIV, such as poverty, or by providing conditional rewards for immediate, measurable outcomes related to HIV care. Incentives have been shown to increase uptake of HIV testing. Yet, few studies to date focus on linkage to care: one large US-based randomized trial failed to show an effect of incentives; a smaller trial showed improved linkage to care among drug users, but no difference in virologic suppression. Several small US-based studies have shown an impact of financial incentives on antiretroviral therapy adherence, but without durability beyond the incentive period. HIV prevention has the most robust evidence for decreasing HIV risk-taking behavior among adolescents and may serve as a model for research on the care cascade. Summary Financial incentives show promise for improving engagement in HIV testing, care, and prevention. Understanding the durability, scalability, ease of implementation, and cost-effectiveness of these different approaches will be critical for maximizing the impact of incentives in curtailing the HIV epidemic.

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Incentivizing HIV/STI Testing: A Systematic Review of the Literature

Cited by 85 publications

References 42 publications

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

Effect of Providing Conditional Economic Compensation on Uptake of Voluntary Medical Male Circumcision in Kenya

Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services

Financial incentives to improve progression through the HIV treatment cascade

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