Effectiveness of Using Additional HIV Self-Test Kits as an Incentive to Increase HIV Testing Within Assisted Partner Services.
Journal
Journal of acquired immune deficiency syndromes (1999)
ISSN: 1944-7884
Titre abrégé: J Acquir Immune Defic Syndr
Pays: United States
ID NLM: 100892005
Informations de publication
Date de publication:
15 Aug 2024
15 Aug 2024
Historique:
received:
19
12
2023
accepted:
11
04
2024
medline:
10
7
2024
pubmed:
10
7
2024
entrez:
10
7
2024
Statut:
ppublish
Résumé
Incentives have shown mixed results in increasing HIV testing rates in low-resource settings. We investigated the effectiveness of offering additional self-tests (HIVSTs) as an incentive to increase testing among partners receiving assisted partner services (APS). Western Kenya. We conducted a single-crossover study nested within a cluster-randomized controlled trial. Twenty-four facilities were randomized 1:1 to (1) control: provider-delivered testing or (2) intervention: offered 1 HIVST or provider-delivered testing for 6 months (pre-implementation), then switched to offering 2 HIVSTs for 6 months (post-implementation). A difference-in-differences approach using generalized linear mixed models, accounting for facility clustering and adjusting for age, sex, and income, was used to estimate the effect of the incentive on HIV testing and first-time testing among partners in APS. March 2021-June 2022, 1127 index clients received APS and named 8155 partners, among whom 2333 reported a prior HIV diagnosis and were excluded from analyses, resulting in 5822 remaining partners: 3646 (62.6%) and 2176 (37.4%) in the pre-implementation and post-implementation periods, respectively. Overall, 944/2176 partners (43%) were offered a second HIVST during post-preimplementation, of whom 34.3% picked up 2 kits, of whom 71.7% reported that the second kit encouraged HIV testing. Comparing partners offered 1 vs. two HIVSTs showed no difference in HIV testing (relative risk: 1.01, 95% confidence interval: 0.951 to 1.07) or HIV testing for the first time (relative risk: 1.23, 95% confidence interval: 0.671 to 2.24). Offering a second HIVST as an incentive within APS did not significantly impact HIV testing or first-time testing, although those opting for 2 kits reported it incentivized them to test.
Sections du résumé
BACKGROUND
BACKGROUND
Incentives have shown mixed results in increasing HIV testing rates in low-resource settings. We investigated the effectiveness of offering additional self-tests (HIVSTs) as an incentive to increase testing among partners receiving assisted partner services (APS).
SETTING
METHODS
Western Kenya.
METHODS
METHODS
We conducted a single-crossover study nested within a cluster-randomized controlled trial. Twenty-four facilities were randomized 1:1 to (1) control: provider-delivered testing or (2) intervention: offered 1 HIVST or provider-delivered testing for 6 months (pre-implementation), then switched to offering 2 HIVSTs for 6 months (post-implementation). A difference-in-differences approach using generalized linear mixed models, accounting for facility clustering and adjusting for age, sex, and income, was used to estimate the effect of the incentive on HIV testing and first-time testing among partners in APS.
RESULTS
RESULTS
March 2021-June 2022, 1127 index clients received APS and named 8155 partners, among whom 2333 reported a prior HIV diagnosis and were excluded from analyses, resulting in 5822 remaining partners: 3646 (62.6%) and 2176 (37.4%) in the pre-implementation and post-implementation periods, respectively. Overall, 944/2176 partners (43%) were offered a second HIVST during post-preimplementation, of whom 34.3% picked up 2 kits, of whom 71.7% reported that the second kit encouraged HIV testing. Comparing partners offered 1 vs. two HIVSTs showed no difference in HIV testing (relative risk: 1.01, 95% confidence interval: 0.951 to 1.07) or HIV testing for the first time (relative risk: 1.23, 95% confidence interval: 0.671 to 2.24).
CONCLUSIONS
CONCLUSIONS
Offering a second HIVST as an incentive within APS did not significantly impact HIV testing or first-time testing, although those opting for 2 kits reported it incentivized them to test.
Identifiants
pubmed: 38985443
doi: 10.1097/QAI.0000000000003455
pii: 00126334-202408150-00006
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
457-464Subventions
Organisme : National Institute of Allergy and Infectious Diseases
ID : R01AI134130
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no funding or conflicts of interest to disclose.
Références
Consolidated guidelines on HIV testing services for a changing epidemic; 2019. Available at: https://www.who.int/publications/i/item/consolidated-guidelines-on-hiv-testing-services-for-a-changing-epidemic. Accessed September 30, 2021.
Brown LB, Miller WC, Kamanga G, et al. Predicting partner HIV testing and counseling following a partner notification intervention. AIDS Behav. 2012;16:1148–1155.
Mugo PM, Micheni M, Shangala J, et al. Uptake and acceptability of oral HIV self-testing among community pharmacy clients in Kenya: a feasibility study. PLoS One. 2017;12:e0170868.
Eshun-Wilson I, Jamil MS, Witzel TC, et al. A systematic review and network meta-analyses to assess the effectiveness of human immunodeficiency virus (HIV) self-testing distribution strategies. Clin Infect Dis. 2021;73:e1018–e1028.
Roy Paladhi U, Katz DA, Otieno G, et al. Effectiveness of HIV self-testing when offered within assisted partner services in western Kenya (APS-HIVST study): A Cluster Randomized Controlled Trial. J Int AIDS Society. 2023. In press.
Njau B, Lisasi E, Damian DJ, et al. Feasibility of an HIV self-testing intervention: a formative qualitative study among individuals, community leaders, and HIV testing experts in northern Tanzania. BMC Public Health. 2020;20:490.
Linnemayr S, MacCarthy S, Wagner Z, et al. Using behavioral economics to promote HIV prevention for key populations. J AIDS Clin Res. 2018;9:780.
Linnemayr S. HIV prevention through the lens of behavioral economics. J Acquir Immune Defic Syndr. 2015;68:e61.
Wagner AD, Njuguna IN, Neary J, et al. Demand creation for HIV testing services: a systematic review and meta-analysis. PLOS Med. 2023;20:e1004169.
Ndyabakira A, Getahun M, Byamukama A, et al. Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda. BMC Public Health. 2019;19:1763.
Montoy JCC, Dow WH, Kaplan BC. Cash incentives versus defaults for HIV testing: a randomized clinical trial. PLoS One. 2018;13:e0199833.
Bassett IV, Wilson D, Taaffe J, et al. Financial incentives to improve progression through the HIV treatment cascade. Curr Opin HIV AIDS. 2015;10:451–463.
Lee R, Cui RR, Muessig KE, et al. Incentivizing HIV/STI testing: a systematic review of the literature. AIDS Behav. 2014;18:905–912.
Nglazi MD, van Schaik N, Kranzer K, et al. An incentivized HIV counseling and testing program targeting hard-to-reach unemployed men in Cape Town, South Africa. J Acquir Immune Defic Syndr 1999. 2012;59:e28-e34. doi:
Zhou Y, Lu Y, Ni Y, et al. Monetary incentives and peer referral in promoting secondary distribution of HIV self-testing among men who have sex with men in China: a randomized controlled trial. PLOS Med. 2022;19:e1003928.
WHO. What Works for Generating Demand for HIV Testing Services; 2019. Available at: https://www.who.int/publications-detail-redirect/WHO-CDS-HIV-19.33. Accessed July 1, 2023.
Operario D, Kuo C, Sosa-Rubí SG, et al. Conditional economic incentives for reducing HIV risk behaviors: integration of psychology and behavioral economics. Health Psychol. 2013;32:932–940.
Chamie G, Schaffer EM, Ndyabakira A, et al. Comparative effectiveness of novel non-monetary incentives to promote HIV testing: a randomized trial. AIDS Lond Engl. 2018;32:1443–1451.
Chamie G, Ndyabakira A, Marson KG, et al. A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda. PLoS One. 2020;15:e0233600.
Chamie G, Kwarisiima D, Ndyabakira A, et al. Financial incentives and deposit contracts to promote HIV retesting in Uganda: a randomized trial. PLoS Med. 2021;18:e1003630.
Choko AT, Corbett EL, Stallard N, et al. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. Plos Med. 2019;16:e1002719.
Sibanda EL, Tumushime M, Mufuka J, et al. Effect of non-monetary incentives on uptake of couples' counselling and testing among clients attending mobile HIV services in rural Zimbabwe: a cluster-randomised trial. Lancet Glob Health. 2017;5:e907–e915.
Difference-in-Difference estimation | Columbia Public health. Available at: https://www.publichealth.columbia.edu/research/population-health-methods/difference-difference-estimation. Accessed October 21, 2021.
Abadie A. Semiparametric difference-in-differences Estimators. Rev Econ Stud. 2005;72:1–19.
R: The R Project for Statistical Computing. Available at: https://www.r-project.org/. Accessed September 27, 2022.
Sharma M, Naughton B, Lagat H, et al. Real-world impact of integrating HIV assisted partner services into 31 facilities in Kenya: a single-arm, hybrid type 2 implementation-effectiveness study. Lancet Glob Health. 2023;11:e749–e758.
Kariithi E, Sharma M, Kemunto E, et al. Using assisted partner services for HIV testing and the treatment of males and their Female sexual partners: protocol for an implementation science study. JMIR Res Protoc. 2021;10:e27262.
McGovern ME, Herbst K, Tanser F, et al. Do gifts increase consent to home-based HIV testing? A difference-in-differences study in rural KwaZulu-Natal, South Africa. Int J Epidemiol. 2016;45:2100–2109.
Rohr JK, Xavier Gómez-Olivé F, Rosenberg M, et al. Performance of self-reported HIV status in determining true HIV status among older adults in rural South Africa: a validation study. J Int AIDS Soc. 2017;20:21691.
Masters SH, Agot K, Obonyo B, et al. Promoting partner testing and couples testing through secondary distribution of HIV self-tests: a randomized clinical trial. PLOS Med. 2016;13:e1002166.
Thirumurthy H, Omanga E, Obonyo B, et al. Using HIV Self-Testing to Promote Male Partner and Couples Testing in Kenya, 3ie Impact Evaluation Report 60; 2017.
Xiao W, Yan L, Chen L, et al. Sexual network distribution of HIV self-testing kits: findings from the process evaluation of an intervention for men who have sex with men in China. PLoS One. 2020;15:e0232094.
Qin Y, Han L, Babbitt A, et al. Experiences using and organizing HIV self-testing: a global qualitative systematic review. AIDS Lond Engl. 2018;32:371–381.
Gebregziabher M, Dai L, Vrana-Diaz C, et al. Gender disparities in receipt of HIV testing results in six sub-Saharan African Countries. Health Equity. 2018;2:384–394.
UNAIDS. 90-90-90: An Ambitious Treat Target Help End AIDS Epidemic. Geneva: UNAIDS; https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf (2014, Accessed May 19, 2023).