A new study from Africa Health Research Institute (AHRI) shows a small financial incentive dramatically increased the uptake of home-based HIV testing among men. The results of the ‘Home-Based Trial to Test and Start’ (HITS) intervention were presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle as a late-breaking abstract on Tuesday, 4 March.
The trial, conducted in the uMkhanyakude district of KwaZulu-Natal, South Africa, was embedded in AHRI’s health and demographic surveillance platform, which offers home-based rapid HIV testing to all adults. The results show that an incentive of a R50 ($3) food voucher increased the uptake of home-based HIV testing by 55%, compared to other interventions and the standard of care. Interestingly, a custom-designed, male-targeted counselling app didn’t increase HIV testing uptake when offered in combination with the financial incentive, or alone.
In South Africa, men are less likely to get tested for HIV and link to care. This contributes to the continued high rates of HIV infection in women, and HIV-related deaths in men in the country. These trial results suggest small financial incentives as a potential solution to improving uptake of HIV testing among men.
“We were surprised at the magnitude of the increase in uptake of testing induced by a relatively small once-off incentive,” said the principal investigator of the trial Professor Frank Tanser. “It’s been a massive challenge to get men to test and link to HIV care, so this is an important finding”.
“This is the first primary outcome from the HITS trial,” added one of the lead authors, Dr Hae-Young Kim – who presented the results at CROI. “We will continue to examine the effect of interventions on other primary outcomes including linkage to care, HIV incidence among young females, HIV-related mortality among men, and population-level viral loads among men. We are also looking at the cost-effectiveness of these intervention strategies.”
Micro-incentives significantly increased the uptake of home-based HIV testing among men in rural South Africa & should be considered as a policy option where testing rates are low. Our Hae-Young Kim presents results from the AHRI ‘HITS’ intervention at #CROI2019 📷via @Tuliodna pic.twitter.com/8IXvkz9tKT
— Africa Health Research Institute (@AHRI_News) March 5, 2019
More about the trial design
HITS randomly allocated all men aged over 15 living in 45 different communities into one of four arms: 1. A financial micro-incentive (a food voucher of R50); 2. Male-targeted counselling 3. Both the financial incentive and the male-targeted counselling, and 4. Standard of care. Of the 2 585 offered one of both of the HITS interventions, 69% consented, and were tested with the rapid home-based HIV test kit. If diagnosed with HIV, participants received a second R50 food voucher when they linked to care within six weeks of the test. The follow-up of participants will continue until the end of 2021.