Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the Hits clinical trial intervention in rural South Africa

Bibliographic Data

ID4600763
AuthorsMaxime Inghels (0000-0002-9340-2054, Centre Population et Développement, corresponding author), Hae‐young Kim (0000-0002-5124-1555, New York University), Hae-Young Kim (0000-0003-2043-2575), Thulile Mathenjwa (0000-0003-2436-9972, Africa Health Research Institute), M Shahmanesh (0000-0001-7129-8535, University College London), Janet Seeley (0000-0002-0583-5272, London School of Hygiene & Tropical Medicine), Sally Wyke (0000-0002-7509-8247, University of Glasgow), Nicky Mcgrath (0000-0002-1039-0159, University of Southampton), Nuala Mcgrath, Benn Sartorius (0000-0001-6761-2325, University of Oxford), H Manisha Yapa (0000-0002-0100-4754, UNSW Sydney), Alexandra Dobra (0000-0001-7793-2197, University of Washington), Adrian Dobra, Till Bärnighausen (0000-0002-4182-4212, Heidelberg University), Frank Tanser (0000-0001-9797-0000, University of Lincoln)
Year2022
Volume311
Pages115305
Publication date2022-10-01
Open AccessYes
TypeARTICLE
VenueSocial Science & Medicine (JOURNAL)
Journal identifiersISSN: 0277-9536 • E-ISSN: 1873-5347
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.socscimed.2022.115305
PMID36084520
OpenAlexW4294000596
LanguageEN
Citations received1
References cited40

In sub-Saharan Africa, home-based HIV testing interventions are designed to reach sub-populations with low access to HIV testing such as men, younger or less educated people. Combining these interventions with conditional financial incentives (CFI) has been shown to be effective to increase testing uptake. CFI are effective for one-off health behaviour change but whether they operate differentially on different socio-demographic groups is less clear. Using data from the HITS trial in South Africa, we investigated whether a CFI was able to reduce existing home-based HIV testing uptake inequalities observed by socio-demographic groups. Residents aged ≥15 years in the study area were assigned to an intervention arm (16 clusters) or a control arm (29 clusters). In the intervention arm, individuals received a food voucher (∼3.5 US dollars) if they accepted to take a home-based HIV test. Testing uptake differences were considered for socio-demographic (sex, age, education, employment status, marital status, household asset index) and geographical (urban/rural living area, distance from clinic) characteristics. Among the 37,028 residents, 24,793 (9290 men, 15,503 women) were included in the analysis. CFI increased significantly testing uptake among men (39.2% vs 25.2%, p < 0.001) and women (45.9% vs 32.0%, p < 0.001) with similar absolute increase between men and women. Uptake was higher amongst the youngest or least educated individuals, and amongst single (vs in union) or unemployed men. Absolute uptake increase was also significantly higher amongst these groups resulting in increasing socio-demographic differentials for home-based HIV testing uptake. However, because these groups are known to have less access to other public HIV testing services, CFI could reduce inequalities for HIV testing access in our specific context. Although CFI significantly increased home-based HIV testing uptake, it did not do so differentially by socio-demographic group. Future interventions using CFI should make sure that the intervention alone does not increase existing health inequities

Environmental health · Marital status · Population · Psychological intervention · Rural area · Adolescent Sexual and Reproductive Health · Demography · Global Maternal and Child Health · HIV/AIDS Research and Interventions · Medicine · Gerontology

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