The impact of financial incentives on HIV incidence among adolescent girls and young women in Eswatini

Sitakhela Likusasa, a cluster randomised trial

Bibliographic Data

ID21880543
AuthorsMarelize Görgens (0000-0002-9258-1767, World Bank Group), Sosthenes Ketende (0000-0002-6050-605X, World Bank Group), Andrew F Longosz (World Bank Group), Mbuso Mabuza (International Rescue Committee), Muziwethu Nkambule (International Rescue Committee), Tengetile Dlamini (International Rescue Committee), Kelvin Sikwibele (Institute for Health Measurement Southern Africa, Mbabane, Eswatini), Vimbai Tsododo (Institute for Health Measurement Southern Africa, Mbabane, Eswatini), Tendai Chipepera (Institute for Health Measurement Southern Africa, Mbabane, Eswatini), Mxolisi Leroy Ndikandika (Institute for Health Measurement Southern Africa, Mbabane, Eswatini), Wendy Heard (World Bank Group), Gugu Maphalala (0000-0002-3635-8405, Ministry of Health), Lindiwe Dlamini (Ministry of Health), D Wilson (0000-0002-7992-901X, Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA), D J Wilson (0000-0003-2786-4688, World Bank Group), Damien De Walque (0000-0003-1592-7602, World Bank Group, corresponding author), Khanya Mabuza (International Rescue Committee)
Year2022
Volume7
Issue9
Pagese007206
Publication date2022-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2021-007206
PMID36113889
OpenAlexW4296163512
LanguageEN
Citations received4
References cited23

Introduction Incentives conditional on school attendance or on remaining free of sexually transmitted infections have produced mixed results in reducing HIV incidence. Methods HIV-negative adolescent girls and young women aged 15–22%–50% of whom were out of school—were recruited from 293 clusters in Eswatini from urban (30%) and rural areas (70%). Financial incentives conditional on education attendance were randomly allocated at the cluster level. All participants were further individually randomised into eligibility for a raffle incentive conditional on random selection into the raffle, on negative tests for syphilis and Trichomonas vaginalis and on being a raffle winner, creating four subarms in a 2×2 factorial design: no-intervention, raffle incentive, education incentive and raffle & education incentive. Randomisation was unblinded to participants. Logistic regressions were used in intention-to-treat analysis of HIV incidence over 3 years to estimate the impact of incentives conditional on school attendance and raffle incentives conditional on remaining sexually transmitted infection free. Results The study recruited 4389 HIV-negative participants, who were distributed into four subarms: no intervention (n=1068), raffle incentive (n=1162), education incentive (n=1088) and raffle and education incentive (n=1071). At endline, 272 participants from 3772 for whom endline data were collected, tested positive for HIV. HIV incidence among participants in education treatment arm was significantly lower than in the education control arm, 6.34% (119/1878) versus 8.08% (153/1894) (p=0.041); OR: 0.766 (0.598 to 0.981); adjusted OR (aOR): 0.754 (0.585 to 0.972). Compared with the no intervention subarm, HIV incidence in the raffle and education incentive subarm was significantly lower, 5.79% (54/878) versus 8.84% (80/905); OR: 0.634 (0.443 to 0.907); aOR: 0.622 (0.433 to 0.893), while it was not significantly lower in the raffle incentive subarm. Conclusion Financial incentives conditional on education participation significantly reduced HIV infection among adolescent girls and young women in Eswatini and appear to be a promising tool for prevention in high HIV prevalence settings. Trial registration number Western Institutional Review Board—protocol number 20 141 630. Eswatini National Health Research Review Board—FWA00026661. Pan African Clinical Trials Registry—PACTR201811609257043

Attendance · Cluster randomised controlled trial · Economics · Environmental health · Incentive · Population · Randomized controlled trial · Transactional sex · Adolescent Sexual and Reproductive Health · Demography · HIV/AIDS Impact and Responses · HIV/AIDS Research and Interventions · Medicine · Surgery

Tools

Open DOIOpen Access