Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa

Inghels, M. et al. (2022) Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa. Social Science and Medicine, 311, 115305. (doi: 10.1016/j.socscimed.2022.115305) (PMID:36084520)

Abstract

In sub-Saharan Africa, home-based HIV testing interventions are designed to reach sub-populations with low access to HIV testing such as men, younger or less educated people. Combining these interventions with conditional financial incentives (CFI) has been shown to be effective to increase testing uptake. CFI are effective for one-off health behaviour change but whether they operate differentially on different socio-demographic groups is less clear. Using data from the HITS trial in South Africa, we investigated whether a CFI was able to reduce existing home-based HIV testing uptake inequalities observed by socio-demographic groups. Residents aged ≥15 years in the study area were assigned to an intervention arm (16 clusters) or a control arm (29 clusters). In the intervention arm, individuals received a food voucher (∼3.5 US dollars) if they accepted to take a home-based HIV test. Testing uptake differences were considered for socio-demographic (sex, age, education, employment status, marital status, household asset index) and geographical (urban/rural living area, distance from clinic) characteristics. Among the 37,028 residents, 24,793 (9290 men, 15,503 women) were included in the analysis. CFI increased significantly testing uptake among men (39.2% vs 25.2%, p < 0.001) and women (45.9% vs 32.0%, p < 0.001) with similar absolute increase between men and women. Uptake was higher amongst the youngest or least educated individuals, and amongst single (vs in union) or unemployed men. Absolute uptake increase was also significantly higher amongst these groups resulting in increasing socio-demographic differentials for home-based HIV testing uptake. However, because these groups are known to have less access to other public HIV testing services, CFI could reduce inequalities for HIV testing access in our specific context. Although CFI significantly home-based HIV testing uptake, it did not do so differentially by socio-demographic group. Future interventions using CFI should make sure that the intervention alone does not increase existing health inequities.

• Item Type: Articles
• Additional Information: The research is funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under Award Number R01AI124389 (PIs: Frank Tanser and Till Bärnighausen). EPIC-HIV development was supported by the Engineering and Physical Sciences Research Council (EPSRC) Interdisciplinary Research Collaboration (IRC) Early-warning Sensing Systems for Infectious Diseases (i-sense) EP/K031953/1 and MRC MR/P024378/1. Frank Tanser and Till Bärnighausen are also supported by the NIH grant (R01-HD084233). The Africa Health Research Institute's Demographic Surveillance Information System and Population Intervention Programme is funded by the Wellcome Trust (201433/A/16/A), and the South Africa Population Research Infrastructure Network (funded by the South African Department of Science and Technology and hosted by the South African Medical Research Council). Nuala McGrath is a recipient of an NIHR Research Professorship award (RP-2017-08-ST2-008).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Wyke, Professor Sally
• Authors: Inghels, M., Kim, H.-Y., Mathenjwa, T., Shahmanesh, M., Seeley, J., Wyke, S., McGrath, N., Sartorius, B., Yapa, H. M., Dobra, A., Bärnighausen, T., and Tanser, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Social Scientists working in Health and Wellbeing
• Journal Name: Social Science and Medicine
• Publisher: Elsevier
• ISSN: 0277-9536
• ISSN (Online): 1873-5347
• Published Online: 01 September 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Social Science and Medicine 311: 115305
• Publisher Policy: Reproduced under a Creative Commons License