Gabriel Chamie1, Alex Ndyabakira2, Kara G Marson1, Devy M Emperador1, Moses R Kamya3, Diane V Havlir1, Dalsone Kwarisiima4, Harsha Thirumurthy5. 1. University of California, San Francisco, California, United States of America. 2. Infectious Diseases Research Collaboration, Mbarara, Uganda. 3. Makerere University College of Health Sciences, Kampala, Uganda. 4. Makerere University Joint AIDS Program, Kampala, Uganda. 5. University of Pennsylvania, Philadelphia, Pennsylvania, United States of America.
Abstract
BACKGROUND: Retesting for HIV is critical to identifying newly-infected persons and reinforcing prevention efforts among at-risk adults. Incentives can increase one-time HIV testing, but their role in promoting retesting is unknown. We sought to test feasibility and acceptability of incentive strategies, including commitment contracts, to promote HIV retesting among at-risk adults in rural Uganda. METHODS:At-risk HIV-negative adults were enrolled in a pilot trial assessing feasibility and acceptability of incentive strategies to promote HIV retesting three months after enrollment. Participants were randomized (1:1:3) to: 1) no incentive; 2) standard cash incentive (~US$4); and 3) commitment contract: participants could voluntarily make a low- or high-value deposit that would be returned with added interest (totaling ~US$4 including the deposit) upon retesting or lost if participants failed to retest. Contracts sought to promote retesting by leveraging loss aversion and addressing present bias via pre-commitment. Outcomes included acceptability of trial enrollment, contract feasibility (proportion of participants making deposits), and HIV retesting uptake. RESULTS: Of 130 HIV-negative eligible adults, 123 (95%) enrolled and were randomized: 74 (60%) to commitment contracts, 25 (20%) to standard incentives, and 24 (20%) to no incentive. Of contract participants, 69 (93%) made deposits. Overall, 93 (76%) participants retested for HIV: uptake was highest in the standard incentive group (22/25 [88%]) and lowest in high-value contract (26/36 [72%]) and no incentive (17/24 [71%]) groups. CONCLUSION: In a randomized trial of strategies to promote HIV retesting among at-risk adults in Uganda, incentive strategies, including commitment contracts, were feasible and had high acceptability. Our findings suggest use of incentives for HIV retesting merits further comparison in a larger trial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT:02890459.
RCT Entities:
BACKGROUND: Retesting for HIV is critical to identifying newly-infectedpersons and reinforcing prevention efforts among at-risk adults. Incentives can increase one-time HIV testing, but their role in promoting retesting is unknown. We sought to test feasibility and acceptability of incentive strategies, including commitment contracts, to promote HIV retesting among at-risk adults in rural Uganda. METHODS: At-risk HIV-negative adults were enrolled in a pilot trial assessing feasibility and acceptability of incentive strategies to promote HIV retesting three months after enrollment. Participants were randomized (1:1:3) to: 1) no incentive; 2) standard cash incentive (~US$4); and 3) commitment contract: participants could voluntarily make a low- or high-value deposit that would be returned with added interest (totaling ~US$4 including the deposit) upon retesting or lost if participants failed to retest. Contracts sought to promote retesting by leveraging loss aversion and addressing present bias via pre-commitment. Outcomes included acceptability of trial enrollment, contract feasibility (proportion of participants making deposits), and HIV retesting uptake. RESULTS: Of 130 HIV-negative eligible adults, 123 (95%) enrolled and were randomized: 74 (60%) to commitment contracts, 25 (20%) to standard incentives, and 24 (20%) to no incentive. Of contract participants, 69 (93%) made deposits. Overall, 93 (76%) participants retested for HIV: uptake was highest in the standard incentive group (22/25 [88%]) and lowest in high-value contract (26/36 [72%]) and no incentive (17/24 [71%]) groups. CONCLUSION: In a randomized trial of strategies to promote HIV retesting among at-risk adults in Uganda, incentive strategies, including commitment contracts, were feasible and had high acceptability. Our findings suggest use of incentives for HIV retesting merits further comparison in a larger trial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT:02890459.
Authors: Dustin Garrett Gibson; Gulam Muhammed Al Kibria; George William Pariyo; Saifuddin Ahmed; Joseph Ali; Alain Bernard Labrique; Iqbal Ansary Khan; Elizeus Rutebemberwa; Meerjady Sabrina Flora; Adnan Ali Hyder Journal: J Med Internet Res Date: 2022-05-09 Impact factor: 7.076
Authors: Gabriel Chamie; Dalsone Kwarisiima; Alex Ndyabakira; Kara Marson; Carol S Camlin; Diane V Havlir; Moses R Kamya; Harsha Thirumurthy Journal: PLoS Med Date: 2021-05-04 Impact factor: 11.069
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