Financial Incentives for Pediatric HIV Testing (FIT): Caregiver Insights on Incentive Mechanisms, Focus Populations,...

Area of Science:

• Global Health
• Pediatric Infectious Diseases
• Health Economics

Background:

• Children living with HIV globally face significant gaps in HIV testing, contributing to preventable mortality.
• Scaling up evidence-based testing strategies is crucial for improving pediatric HIV outcomes.
• Financial incentives (FI) have shown promise in increasing pediatric HIV testing uptake.

Purpose of the Study:

• To explore caregiver perspectives on the feasibility and acceptability of financial incentives for pediatric HIV testing.
• To identify considerations for the broader implementation of financial incentives in HIV testing programs.
• To understand potential unintended consequences of using financial incentives for pediatric HIV testing.

Main Methods:

• Qualitative follow-up study to the FIT trial (NCT03049917) conducted in Kenya.
• Individual interviews with 54 caregivers of children undergoing HIV testing.
• Thematic analysis of interview transcripts to identify key considerations for scaling up FI.

Main Results:

• Caregivers reported that FI motivate testing by offsetting costs and encouraging timely action.
• FI were perceived as feasible and acceptable for widespread programmatic use across diverse populations.
• Concerns included potential misuse (e.g., bringing ineligible children) and fears of caregiver dependency impacting care linkage and retention.

Conclusions:

• Financial incentives are a feasible and acceptable strategy for increasing pediatric HIV testing.
• Programmatic implementation requires addressing potential unintended consequences to ensure sustained engagement in care.
• Further research should explore strategies to mitigate risks and optimize FI for long-term HIV management in children.