Incentive-based interventions to improve HIV prevention and care continuum: a global systematic review and...

Incentive-based intervention has been widely implemented for HIV prevention and care, necessitating an urgent evidence-based synthesis of the extensive new evidence.

We conducted a global systematic review and meta-analysis (PROSPERO: CRD42022368634) of randomised controlled trials (RCTs) identified through MEDLINE, Web of Science, and Google Scholar, Embase, Scopus, and region-specific databases (inception to Sep 10, 2024). Two reviewers independently selected studies using the Covidence online tool. Eligible studies with money-type, non-money type, and lottery type of incentives reporting outcomes along HIV prevention and care continuum were included. Cochrane Risk-of -Bias Tool (ROB) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach were used to assess risk of bias and evidence grading. We pooled risk ratio (RR) using random-effects model versus standard care.

We included 62 RCTs with 118,432 participants from 16 countries, over half of which were published in the recent five years. Compared to standard care, incentive-based intervention was associated with improvements from a 1.8 times increase in HIV testing uptakes (15 studies, 82,327 participants, RR 1.83 [95% CI: 1.31-2.54], I² = 99%) to a 1.25 times increase in viral suppression (14 studies, 14,341 participants, RR 1.25 [1.14-1.38], I² = 75%). When limited to monetary-type incentives, it is associated with 2.13 times of HIV testing uptakes (nine studies, 17,320 participants, [95% CI: 1.36-3.33], I² = 98%). When limited to studies with 2-3 months implementation, it is associated with 2.82 times of HIV testing uptakes (four studies, 25,167 participants, [95% CI: 1.10-7.21], I² = 98%) The effect of incentives varied across countries with different income levels, but consistent across different sexes. There were negative effects found in studies with outcomes of reducing HIV incidence, STI prevalence, and mortality.

Incentive-based interventions are associated with improved outcomes across the HIV prevention and care continuum, with inconsistency between incentive types, implementation duration, income-levels of countries. The results of its implementation, including outcomes and sustainability, are required to maximize its effectiveness in practice.

National Natural Science Foundation of China and Guangdong Province (Grant No. 82304201 and 2024A1515012123).