HIV testing rate among children and adolescents boosted after caregivers receive a cash incentive

Children and adolescents are more likely to be tested for HIV if their parents or caregivers are offered a cash incentive, according to the results of a study conducted in Zimbabwe and published in The Lancet HIV. Offering the small cash incentive more than doubled the proportion of children undergoing testing.

“Uptake of HIV testing by children and adolescents in households that received a financial incentive was higher than in households that did not receive an incentive,” comment the authors. “A lottery with a one in eight probability of receiving an incentive had a similar effect on HIV testing as a fixed incentive of $2.”

The authors of an editorial accompanying the study believe its findings provide “a compelling case for incentivised programmatic HIV testing.”

Glossary

control group

A group of participants in a trial who receive standard treatment, or no treatment at all, rather than the experimental treatment which is being tested. Also known as a control arm.

boosting agent

Booster drugs are used to ‘boost’ the effects of protease inhibitors and some other antiretrovirals. Adding a small dose of a booster drug to an antiretroviral makes the liver break down the primary drug more slowly, which means that it stays in the body for longer times or at higher levels. Without the boosting agent, the prescribed dose of the primary drug would be ineffective.

cost-effective

Cost-effectiveness analyses compare the financial cost of providing health interventions with their health benefit in order to assess whether interventions provide value for money. As well as the cost of providing medical care now, analyses may take into account savings on future health spending (because a person’s health has improved) and the economic contribution a healthy person could make to society.

odds

Expresses how likely a person is to experience an event, compared to how likely the person is not to experience the event. An odds above 1 means that the event is more likely to happen than not.

Diagnosis is an essential first step to access HIV treatment, care and prevention services. Because of late diagnosis, HIV-related mortality is increasing among older children and adolescents. An international team of investigators wanted to see if the provision of cash incentives to parents/caregivers boosted HIV testing rates among their children.

They therefore designed a randomised controlled study involving 1688 households where there was at least one untested child/adolescent aged between 8 and 17 years in Harare.

To see if cash incentives boosted testing rates, the households were randomised into one of three groups: no incentive (control group); fixed $2 incentive for testing; entry into a lottery with a one-in-eight chance of winning $5 or $10 for testing.

The study outcome was the proportion of children tested within four weeks of randomisation.

The research was conducted in late 2015. Participating households had an average monthly income of $100.

At least one child was tested for HIV in 20% of households in the control arm. This compared to a testing rate of 48% for households offered the $2 fixed incentive and 40% for households eligible for entry into the lottery.

The odds of testing were significantly higher (p < 0.0001) in both the fixed incentive and lottery groups when compared to the control arm.

“Our findings show that incentives targeted at caregivers substantially improve HIV testing rates in adolescents,” conclude the authors. “Looking forward, the cost-effectiveness of this approach must be studied, and careful thought must be given to the social and cultural context if strategies such as this are to be brought to scale.”

The authors of the editorial were impressed by the study, but suggest that there are ethical and long-term affordability issues related to offering cash incentives that need to be considered.

References

Kranzer K et al. Economic incentives for HIV testing by adolescents in Zimbabwe: a randomised controlled trial. The Lancet HIV, http://dx.doi.10.1061/s2352-3018(17)30176-5 (2017)

Brown B et al. Crucial but understudied: incentives in HIV research. The Lancet HIV, http://dx.doi.10.1061/s2352-3018(17)30196-0 (2017)