Cash incentives versus defaults for HIV testing: A randomized clinical trial

Area of Science:

• Behavioral Economics
• Public Health
• Clinical Trials

Background:

• Behavioral economics tools can improve health behaviors.
• Efficacy of different interventions for patient behavior is not well-established.
• Study focused on cash incentives and default options to increase HIV test acceptance.

Purpose of the Study:

• To test the influence of small cash incentives, defaults, and their combination on HIV test acceptance.
• To determine the relative efficacy and additive effects of behavioral economics interventions.

Main Methods:

• Randomized clinical trial in an urban emergency department.
• Patients aged 13-64 were cross-randomized to $0, $1, $5, $10 incentives and opt-in, active-choice, or opt-out defaults.
• Primary outcome: proportion of patients accepting an HIV test.

Main Results:

• Overall HIV test acceptance was 55.4%.
• $5 and $10 incentives increased acceptance by 10.5% and 15%, respectively.
• Opt-out defaults increased acceptance by 23.9%, significantly more than active-choice or opt-in.

Conclusions:

• Both small incentives and default options increase HIV test acceptance.
• Combined interventions had less than additive effects.
• Behavioral economics tools warrant consideration by clinicians and policymakers for public health interventions.