“The Money, It’s OK but It’s not OK”: Patients’ and Providers’ Perceptions of the Acceptability of Cash Incentives for HIV Treatment Initiation in Cape Town, South Africa

Swartz, Alison; Maughan-Brown, Brendan; Perera, Shehani; Harrison, Abigail; Kuo, Caroline; Lurie, Mark N.; Smith, Philip J.; Bekker, Linda‐Gail; Galárraga, Omar

doi:10.1007/s10461-021-03355-0

Cited by 7 publications

(8 citation statements)

References 26 publications

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“…The idea of rewarding individuals financially was not met with enthusiasm in a recent investigation in Cape Town, South Africa either. It emerged that incentivisation received a lukewarm reception from some patients as well as healthcare workers, on the grounds of morality ( 30 ). That financial incentivisation, irrespective of the form or monetary value cannot be relied upon to increase engagement with the HIV management continuum amongst adults and particularly male ones has been reinforced in our study too, as the poor responsiveness despite the promise of incentivisation, pointed to it being ineffectual.…”

Section: Discussionmentioning

confidence: 99%

Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result

Majam

Phatsoane

Wonderlik

et al. 2022

Front. Reprod. Health

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IntroductionAchieving viral suppression in people with HIV is crucial in ending the AIDS epidemic. Among users of HIV self-screening tests, low rates of linkage to care and early retention in care are key obstacles to achieving viral suppression. This study sought to evaluate the efficacy of financial incentives in supporting HIV case management.MethodsYoung adults within the inner city of Johannesburg, South Africa and surrounding areas who used HIV self-tests, were able to use WhatsApp to communicate with study personnel, reported a reactive or invalid result, and were confirmed to by HIV-positive were enrolled in the study. Participants were randomised to an intervention arm that received reminders and financial rewards for engaging in care, or to a control arm that received the standard of care. The primary outcome was HIV viral load at six months.ResultsAmong 2,388 HIV self-test kits that were distributed, 1757/2,388 (73,58%) recipients were able to use their phones to send photos to study personnel. 142/1,757 (8,08%) of these recipients reported reactive or invalid results. Upon confirmatory testing, 99/142 (69,71%) participants were identified as being HIV-positive and were enrolled in the study. 2 (1,41%) participants received an HIV negative result, and 41(28,87%) participants were either lost to follow-up or did not complete the confirmatory testing step. 20/99 (20,2%) from the intervention arm and 18/99 (18,18%) from the control arm completed the study (i.e., attended a 6 month follow up and participated in the exit interview). 29/99 (29,29%) were virally suppressed by at 6 months. Of those achieving viral suppression 15 (51,72%) were from the intervention arm.ConclusionFinancial incentives and reminders were not effective in promoting engagement with HIV care and viral suppression in this setting.

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Section: Discussionmentioning

confidence: 99%

Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result

Majam

Phatsoane

Wonderlik

et al. 2022

Front. Reprod. Health

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“…By contrast another South African study showed that both patients and providers generally did not link financial incentivisation with structural barriers to the HIV cascade like transport costs or food insecurity, but rather with individual factors like intrinsic motivation. 38 Even though most participants thought financial incentives were a positive influence on linkage and retention, a few participants expressed that financial incentivisation should not be used in the HIV care continuum because being responsible for one's health behaviour is the most important factor. This finding is supported by Clouse et al's findings from a study on acceptability and feasibility of financial incentives among pregnant South African women, where it was found that participants deemed health education and counselling to be more important than financial incentives.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Experiences in receiving financial incentives to access HIV care in Johannesburg, South Africa

Schlehr

Singh²,

Nyatela³

et al. 2022

Southern African Journal of HIV Medicine

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Background: Financial incentivisation has been used to improve all steps of the HIV cascade with varying results. Most studies conducted on the matter are of a quantitative nature, not giving enough space for in-depth understanding as to why financial incentives work or do not work.Objectives: To describe experiences with, and opinions on, the use of financial incentives to promote linkage to and retention in care from the perspective of people living with HIV.Method: We performed a qualitative cross-sectional study. In-depth interviews were conducted with adult men and women with HIV accessing health services or research study visits. After codebook development, NVivo 12 software was used to code and analyse the data.Results: Through the provision of financial incentives, participants were able to cover basic needs. However, some deemed financial incentives as a form of income rather than a nudge to spark interest in changing their health behaviour. Participants communicated that a need for some type of incentive exists and recommended food vouchers as the best possible solution.Conclusion: Financial incentivisation can facilitate engagement in the HIV care continuum through providing support to people living with HIV.What this study adds: This study complements the body of research that explores the feasibility of using incentives and which of them may be most beneficial in encouraging patients with HIV to enter into and sustain HIV care.

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“…Seven linkage to care studies reported qualitative results (12%, n = 7/57) (Table 6). In two studies on cash-based incentives (∼$25) in the United States and South Africa, participants felt that while incentives may increase linkage to care, they may also elicit ethical discussions [86,87]. Two studies from South Africa reported qualitative results from multiple interventions.…”

Section: Qualitative Values and Preferencesmentioning

confidence: 99%

“…Case management [33] Additional support for accompanied referrals and fast-tracking encouraged clients to access PrEP Some providers did not complete screening if they perceived clients to be at low risk for HIV, or if they had a heavy workload Linkage to HIV care Incentives [85][86][87] Cash incentives were appreciated.…”

Section: Linkage To Hiv Preventionmentioning

confidence: 99%

Understanding effective post‐test linkage strategies for HIV prevention and care: a scoping review

Wamuti,

Jamil,

Siegfried

et al. 2024

J Int AIDS Soc.

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IntroductionFollowing HIV testing services (HTS), the World Health Organization recommends prompt linkage to prevention and treatment. Scale‐up of effective linkage strategies is essential to achieving the global 95‐95‐95 goals for maintaining low HIV incidence by 2030 and reducing HIV‐related morbidity and mortality. Whereas linkage to care including same‐day antiretroviral therapy (ART) initiation for all people with HIV is now routinely implemented in testing programmes, linkage to HIV prevention interventions including behavioural or biomedical strategies, for HIV‐negative individuals remains sub‐optimal. This review aims to evaluate effective post‐HTS linkage strategies for HIV overall, and highlight gaps specifically in linkage to prevention.MethodsUsing the five‐step Arksey and O'Malley framework, we conducted a scoping review searching existing published and grey literature. We searched PubMed, Cochrane Library, CINAHL, Web of Science and EMBASE databases for English‐language studies published between 1 January 2010 and 30 November 2023. Linkage interventions included as streamlined interventions—involving same‐day HIV testing, ART initiation and point‐of‐care CD4 cell count/viral load, case management—involving linkage coordinators developing personalized HIV care and risk reduction plans, incentives—financial and non‐financial, partner services—including contact tracing, virtual—like social media, quality improvement—like use of score cards, and peer‐based interventions. Outcomes of interest were linkage to any form of HIV prevention and/or care including ART initiation.ResultsOf 2358 articles screened, 66 research studies met the inclusion criteria. Only nine linkage to prevention studies were identified (n = 9/66, 14%)—involving pre‐exposure prophylaxis, voluntary medical male circumcision, sexually transmitted infection and cervical cancer screening. Linkage to care studies (n = 57/66, 86%) focused on streamlined interventions in the general population and on case management among key populations.DiscussionDespite a wide range of HIV prevention interventions available, there was a dearth of literature on HIV prevention programmes and on the use of messaging on treatment as prevention strategy. Linkage to care studies were comparatively numerous except those evaluating virtual interventions, incentives and quality improvement.ConclusionsThe findings give insights into linkage strategies but more understanding of how to provide these effectively for maximum prevention impact is needed.

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“The Money, It’s OK but It’s not OK”: Patients’ and Providers’ Perceptions of the Acceptability of Cash Incentives for HIV Treatment Initiation in Cape Town, South Africa

Cited by 7 publications

References 26 publications

Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result

Incentives to promote accessing HIV care and viral suppression among HIV self-screening test users who obtain a reactive result

Experiences in receiving financial incentives to access HIV care in Johannesburg, South Africa

Understanding effective post‐test linkage strategies for HIV prevention and care: a scoping review

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