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Financial incentives to increase pediatric HIV testing: a randomized trial

Irene N Njuguna1,2,3, Anjuli D Wagner2, Jillian Neary1

  • 1Department of Epidemiology.

AIDS (London, England)
|October 13, 2020
PubMed

Insights

Financial incentives significantly increased pediatric HIV testing rates among caregivers living with HIV. Higher incentive amounts led to faster testing times, demonstrating their effectiveness in improving child HIV testing outcomes.

Area of Science:

  • Public Health
  • Global Health
  • Pediatric Infectious Diseases

Background:

  • Financial incentives are known motivators for adult health behaviors like HIV testing.
  • Limited data exists on the efficacy of financial incentives for pediatric HIV testing, a critical intervention to prevent child mortality.
  • Urgent need to identify effective strategies for timely pediatric HIV diagnosis.

Purpose of the Study:

  • To evaluate the effectiveness of varying financial incentives on increasing pediatric HIV testing rates among caregivers living with HIV.
  • To assess the impact of financial incentives on the time to pediatric HIV testing.

Main Methods:

  • A five-arm unblinded randomized controlled trial was conducted in 19 HIV clinics in Western Kenya.
  • Adults living with HIV with children aged 0-12 years of unknown HIV status were randomized to receive $0, $1.25, $2.50, $5, or $10.
  • Child HIV testing within two months was the primary outcome, with time to testing also analyzed. The study was registered under NCT03049917.

Main Results:

  • Caregivers receiving higher incentives showed increased pediatric HIV testing uptake. Specifically, the $10 incentive arm had significantly higher testing completion rates (61%) compared to the $0 arm (34%).
  • A dose-response relationship was observed, with significantly faster time to testing in the $5 and $10 incentive groups compared to the control group.
  • The $10 incentive group showed a relative risk of 1.80 for testing completion, and hazard ratios of 1.95 and 2.42 for faster testing in the $5 and $10 arms, respectively.

Conclusions:

  • Financial incentives are effective in improving pediatric HIV testing among caregivers living with HIV.
  • The study highlights the potential of financial incentives as a public health tool to enhance pediatric HIV testing and reduce mortality.
  • Tailoring incentive amounts based on observed effectiveness can optimize pediatric HIV testing strategies.
Abstract

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