Journal article
Increasing HIV testing and linkage to care among men in rural South Africa using conditional financial incentives and a decision support app: A process evaluation
PLOS global public health, Vol.4(6), e0003364
06/18/2024
DOI: 10.1371/journal.pgph.0003364
PMCID: PMC11185444
PMID: 38889120
Abstract
Men in sub-Saharan Africa are less likely to accept HIV testing and link to HIV care than women. We conducted a trial to investigate the impact of conditional financial incentives and a decision support application, called EPIC-HIV, on HIV testing and linkage to care. We report the findings of the trial process evaluation to explore whether the interventions were delivered as intended, identify mechanisms of impact and any contextual factors that may have impacted the trial outcomes. Between August 2018 and March 2019, we conducted in-depth interviews and focus group discussions with trial participants (n = 31) and staff (n = 14) to examine views on the implementation process, participant responses to the interventions and the external factors that may have impacted the implementation and outcomes of the study. Interviews were audio-recorded, transcribed, and translated where necessary, and thematically analyzed using ATLAS-ti and NVivo. Both interventions were perceived to be acceptable and useful by participants and implementers. EPIC-HIV proved challenging to implement as intended because it was difficult to ensure consistent use of earphones, and maintenance of privacy. Some participants struggled to navigate the EPIC-HIV app independently and select stories that appealed to them without support. Some participants stopped exploring the app before the end, resulting in an incomplete use of EPIC-HIV. While the financial incentive was implemented as intended, there were challenges with eligibility. The convenience and privacy of home testing influenced the uptake of HIV testing. Contextual barriers including fear of HIV stigma and disclosure if diagnosed with HIV, and expectations of poor treatment in clinics may have inhibited linkage to care. Financial incentives were relatively straightforward to implement and increased uptake of home-based rapid HIV testing but were not sufficient as a ‘stand-alone’ intervention. Barriers like fear of stigma should be addressed to facilitate linkage to care.
Details
- Title: Subtitle
- Increasing HIV testing and linkage to care among men in rural South Africa using conditional financial incentives and a decision support app: A process evaluation
- Creators
- Thulile Mathenjwa - Africa Health Research InstituteLuchuo Engelbert Bain - University of JohannesburgOluwafemi Adeagbo - University of IowaHae-Young KimMaxime Inghels - University of LincolnThembelihle Zuma - Africa Health Research InstituteSally Wyke - University of GlasgowMaryam Shahmanesh - University College LondonNuala McGrath - University of SouthamptonAnn Blandford - University College LondonPhilippa Matthews - Africa Health Research InstituteDickman Gareta - Africa Health Research InstituteManisha YapaTill Bärnighausen - Heidelberg UniversityFrank Tanser - Stellenbosch UniversityJanet Seeley - London School of Hygiene & Tropical Medicine
- Resource Type
- Journal article
- Publication Details
- PLOS global public health, Vol.4(6), e0003364
- Publisher
- Public Library of Science
- DOI
- 10.1371/journal.pgph.0003364
- PMID
- 38889120
- PMCID
- PMC11185444
- ISSN
- 2767-3375
- eISSN
- 2767-3375
- Grant note
- ; EP/K031953/1 and MRC MR/P024378/1 / ; 201433/Z/16/Z / ; R01AI124389 / ;
- Alternative title
- HITS process evaluation
- Language
- English
- Date published
- 06/18/2024
- Academic Unit
- Community and Behavioral Health
- Record Identifier
- 9984648575502771
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