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
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
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 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.
Financial incentives, HIV, Home-based HIV testing, Inequalities, South Africa
Inghels, Maxime
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Kim, Hae-Young
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Mathenjwa, Thulile
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Shahmanesh, Maryam
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Seeley, Janet
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Wyke, Sally
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Mcgrath, Nuala
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Sartorius, Ben
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Yapa, H.M.
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Dobra, Adrian
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Barnighausen, Till Winfried
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Tanser, Frank
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October 2022
Inghels, Maxime
11722dfa-1778-47e0-8a64-f7473f2f63a2
Kim, Hae-Young
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Mathenjwa, Thulile
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Shahmanesh, Maryam
d88581c9-0ef2-4506-b8d3-d72682936a09
Seeley, Janet
f3106c01-ac91-4ffc-945a-6db3558fd8eb
Wyke, Sally
969980b4-2c66-4015-add3-7f3985af21cd
Mcgrath, Nuala
b75c0232-24ec-443f-93a9-69e9e12dc961
Sartorius, Ben
632a8d47-c2dc-4c6b-9f7d-49d226fe6093
Yapa, H.M.
b8b30d61-3eb3-4668-8460-fcdd8b3b99b1
Dobra, Adrian
3754beab-767d-4b2a-abf4-184b8363eb23
Barnighausen, Till Winfried
f99001d2-60f1-4447-b554-b01dca4b4c5e
Tanser, Frank
a7112c48-809b-4f7c-8662-eaef445891f4
Inghels, Maxime, Kim, Hae-Young, Mathenjwa, Thulile, Shahmanesh, Maryam, Seeley, Janet, Wyke, Sally, Mcgrath, Nuala, Sartorius, Ben, Yapa, H.M., Dobra, Adrian, Barnighausen, Till Winfried and Tanser, Frank
(2022)
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.
Social Science & Medicine, 311, [115305].
(doi:10.1016/j.socscimed.2022.115305).
Abstract
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 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.
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Accepted/In Press date: 17 August 2022
e-pub ahead of print date: 1 September 2022
Published date: October 2022
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Funding Information:
The research is funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under Award Number R01AI124389 (PIs: Frank Tanser and Till Bärnighausen). EPIC-HIV development was supported by the Engineering and Physical Sciences Research Council (EPSRC) Interdisciplinary Research Collaboration (IRC) Early-warning Sensing Systems for Infectious Diseases (i-sense) EP/K031953/1 and MRC MR/P024378/1. Frank Tanser and Till Bärnighausen are also supported by the NIH grant (R01-HD084233). The Africa Health Research Institute's Demographic Surveillance Information System and Population Intervention Programme is funded by the Wellcome Trust (201433/A/16/A), and the South Africa Population Research Infrastructure Network (funded by the South African Department of Science and Technology and hosted by the South African Medical Research Council). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding bodies. Nuala McGrath is a recipient of an NIHR Research Professorship award (RP-2017-08-ST2-008).
Funding Information:
The research is funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under Award Number R01AI124389 (PIs: Frank Tanser and Till Bärnighausen). EPIC-HIV development was supported by the Engineering and Physical Sciences Research Council (EPSRC) Interdisciplinary Research Collaboration (IRC) Early-warning Sensing Systems for Infectious Diseases (i-sense) EP/K031953/1 and MRC MR/P024378/1 . Frank Tanser and Till Bärnighausen are also supported by the NIH grant ( R01-HD084233 ). The Africa Health Research Institute's Demographic Surveillance Information System and Population Intervention Programme is funded by the Wellcome Trust ( 201433/A/16/A ), and the South Africa Population Research Infrastructure Network (funded by the South African Department of Science and Technology and hosted by the South African Medical Research Council ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding bodies. Nuala McGrath is a recipient of an NIHR Research Professorship award ( RP-2017-08-ST2-008 ).
Publisher Copyright:
© 2022 The Authors
Keywords:
Financial incentives, HIV, Home-based HIV testing, Inequalities, South Africa
Identifiers
Local EPrints ID: 472068
URI: http://eprints.soton.ac.uk/id/eprint/472068
ISSN: 0277-9536
PURE UUID: cb3baf5d-426b-453c-89f2-d69796f5fa25
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Date deposited: 24 Nov 2022 18:41
Last modified: 17 Mar 2024 03:32
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Contributors
Author:
Maxime Inghels
Author:
Hae-Young Kim
Author:
Thulile Mathenjwa
Author:
Maryam Shahmanesh
Author:
Janet Seeley
Author:
Sally Wyke
Author:
Ben Sartorius
Author:
H.M. Yapa
Author:
Adrian Dobra
Author:
Till Winfried Barnighausen
Author:
Frank Tanser
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