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A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda

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  • Gabriel Chamie
  • Alex Ndyabakira
  • Kara G Marson
  • Devy M Emperador
  • Moses R Kamya
  • Diane V Havlir
  • Dalsone Kwarisiima
  • Harsha Thirumurthy

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

Suggested Citation

  • Gabriel Chamie & Alex Ndyabakira & Kara G Marson & Devy M Emperador & Moses R Kamya & Diane V Havlir & Dalsone Kwarisiima & Harsha Thirumurthy, 2020. "A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda," PLOS ONE, Public Library of Science, vol. 15(5), pages 1-10, May.
    • Handle: RePEc:plo:pone00:0233600
    DOI: 10.1371/journal.pone.0233600
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    References listed on IDEAS

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    1. Chaeyoung Lee & Soobin Kwak & Junseok Kim, 2021. "Controlling COVID-19 Outbreaks with Financial Incentives," IJERPH, MDPI, vol. 18(2), pages 1-13, January.

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