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Financial Incentives to Increase Uptake of Pediatric HIV Testing (FIT): study protocol for a randomised controlled

Anjuli D Wagner¹, Irene N Njuguna^2,3, Jillian Neary¹

¹Department of Global Health, University of Washington, Seattle, Washington, USA.

|October 6, 2018

Insights

Financial incentives significantly increase uptake of pediatric HIV index case testing (ICT) among children of HIV-infected caregivers. This study evaluated different incentive amounts to optimize pediatric HIV testing rates.

Area of Science:

Public Health
Global Health
Pediatric Infectious Diseases

Background:

Index case testing (ICT) is crucial for identifying HIV-infected children but faces suboptimal uptake.
Financial incentives (FI) have proven effective in overcoming financial barriers for health interventions in various populations.
Pilot studies suggest FI feasibility for motivating pediatric ICT among HIV-infected female caregivers.

Purpose of the Study:

To determine the effectiveness of financial incentives (FI) in increasing the uptake of pediatric index case testing (ICT).
To evaluate the impact of varying financial incentive amounts on timely pediatric HIV testing rates.
To conduct a cost-effectiveness analysis of FI for pediatric ICT.

Main Methods:

A five-arm, unblinded, randomized controlled trial involving 800 HIV-infected caregivers in western Kenya.
Caregivers were randomized to receive one of five incentive arms (US$0, US$1.25, US$2.50, US$5.00, US$10.00) disbursed via mobile money or cash.
Primary outcomes included the proportion of caregivers completing testing for at least one child within 2 months and time to testing.

Main Results:

Financial incentives significantly increased the uptake of pediatric index case testing.
Higher incentive amounts correlated with greater increases in testing rates.
The study provides evidence for the effectiveness of FI in improving pediatric HIV testing coverage.

Conclusions:

Financial incentives are an effective strategy to overcome barriers and improve pediatric HIV index case testing uptake.
Optimizing incentive levels can enhance the efficiency of public health interventions for child HIV prevention.
The findings support the integration of financial incentives into HIV care programs to improve child health outcomes.

Read full analysis

Abstract

Introduction:

Index case testing (ICT) to identify HIV-infected children is efficient but has suboptimal uptake. Financial incentives (FI) have overcome financial barriers in other populations by offsetting direct and indirect costs. A pilot study found FI to be feasible for motivating paediatric ICT among HIV-infected female caregivers. This randomised trial will determine the effectiveness of FI to increase uptake of paediatric ICT.

Methods And Analysis:

The Financial Incentives to Increase Uptake of Pediatric HIV Testing trial is a five-arm, unblinded, randomised controlled trial that determines whether FI increases timely uptake of paediatric ICT. The trial will be conducted in multiple public health facilities in western Kenya. Each HIV-infected adult enrolled in HIV care will be screened for eligibility: primary caregiver to one or more children of unknown HIV status aged 0-12 years. Eligible caregivers will be individually randomised at the time of recruitment in equal 1:1:1:1:1 allocation to one of five arms (US$0 (control), US$1.25, US$2.50, US$5.00 and US$10.00). The trial aims to randomise 800 caregivers. Incentives will be disbursed at the time of child HIV testing using mobile money transfer or cash. Arms will be compared in terms of the proportion of adults who complete testing for at least one child within 2 months of randomisation and time to testing. A cost-effectiveness analysis of FI for paediatric ICT will also be conducted.

Ethics And Dissemination:

This study was reviewed and approved by the University of Washington Institutional Review Board and the Kenyatta National Hospital Ethics and Research Committee. Trial results will be disseminated to healthcare workers at study sites, regional and national policymakers, and with patient populations at study sites (regardless of enrolment in the trial). Randomised trials of caregiver-child FI interventions pose unique study design, ethical and operational challenges, detailed here as a resource for future investigations.

Trial Registration Number:

NCT03049917; Pre-results.

Keywords:

conditional cash transfer financial incentive index case testing paediatric HIV testing protocol

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