Journal article
Population impacts of conditional financial incentives and a male‐targeted digital decision support application on the HIV treatment cascade in rural KwaZulu Natal: findings from the HITS cluster randomized clinical trial
Journal of the International AIDS Society, Vol.27(5), e26248
05/2024
DOI: 10.1002/jia2.26248
PMCID: PMC11063775
PMID: 38695099
Abstract
Introduction
In South Africa, the HIV care cascade remains suboptimal. We investigated the impact of small conditional financial incentives (CFIs) and male-targeted HIV-specific decision-support application (EPIC-HIV) on the HIV care cascade.
Methods
In 2018, in uMkhanyakude district, 45 communities were randomly assigned to one of four arms: (i) CFI for home-based HIV testing and linkage to care within 6 weeks (R50 [US$3] food voucher each); (ii) EPIC-HIV which are based on self-determination theory; (iii) both CFI and EPIC-HIV; and (iv) standard of care. EPIC-HIV consisted of two components: EPIC-HIV 1, provided to men through a tablet before home-based HIV testing, and EPIC-HIV 2, offered 1 month later to men who tested positive but had not yet linked to care. Linking HITS trial data to national antiretroviral treatment (ART) programme data and HIV surveillance programme data, we estimated HIV status awareness after the HITS trial implementation, ART status 3 month after the trial and viral load suppression 1 year later. Analysis included all known individuals living with HIV in the study area including those who did not participated in the HITS trial.
Results
Among the 33,778 residents in the study area, 2763 men and 7266 women were identified as living with HIV by the end of the intervention period and included in the analysis. After the intervention, awareness of HIV-positive status was higher in the CFI arms compared to non-CFI arms (men: 793/908 [87.3%] vs. 1574/1855 [84.9%], RR = 1.03 [95% CI: 0.99−1.07]; women: 2259/2421 [93.3%] vs. 4439/4845 [91.6%], RR = 1.02 [95% CI: 1.00−1.04]). Three months after the intervention, no differences were found for linkage to ART between arms. One year after the intervention, only 1829 viral test results were retrieved. Viral suppression was higher but not significant in the EPIC-HIV intervention arms among men (65/99 [65.7%] vs. 182/308 [59.1%], RR = 1.11 [95% CI: 0.88−1.40]).
Conclusions
Small CFIs can contribute to achieve the first step of the HIV care cascade. However, neither CFIs nor EPIC-HIV was sufficient to increase the number of people on ART. Additional evidence is needed to confirm the impact of EPIC-HIV on viral suppression.
Details
- Title: Subtitle
- Population impacts of conditional financial incentives and a male‐targeted digital decision support application on the HIV treatment cascade in rural KwaZulu Natal: findings from the HITS cluster randomized clinical trial
- Creators
- Maxime Inghels - University of LincolnHae‐Young Kim - Africa Health Research InstituteThulile Mathenjwa - Africa Health Research InstituteMaryam Shahmanesh - University College LondonJanet Seeley - London School of Hygiene & Tropical MedicineSally Wyke - University of GlasgowPhilippa Matthews - Africa Health Research InstituteOluwafemi Adeagbo - University of IowaDickman Gareta - Africa Health Research InstituteNuala McGrath - University of SouthamptonH. Manisha Yapa - Africa Health Research InstituteAnn Blandford - University College LondonThembelihle Zuma - Africa Health Research InstituteAdrian Dobra - University of WashingtonTill Bärnighausen - Heidelberg UniversityFrank Tanser - Africa Health Research Institute
- Resource Type
- Journal article
- Publication Details
- Journal of the International AIDS Society, Vol.27(5), e26248
- Publisher
- John Wiley and Sons Inc
- DOI
- 10.1002/jia2.26248
- PMID
- 38695099
- PMCID
- PMC11063775
- eISSN
- 1758-2652
- Grant note
- South Africa Population Research Infrastructure Network EP/K031953/1 / Engineering and Physical Sciences Research Council, Interdisciplinary Research Collaboration (IRC) MR/P024378/1 / Medical Research Council (MRC)
- Language
- English
- Date published
- 05/2024
- Academic Unit
- Community and Behavioral Health
- Record Identifier
- 9984622896702771
Metrics
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