IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v311y2022ics0277953622006116.html
   My bibliography  Save this article

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

Author

Listed:
  • Inghels, Maxime
  • Kim, Hae-Young
  • Mathenjwa, Thulile
  • Shahmanesh, Maryam
  • Seeley, Janet
  • Wyke, Sally
  • McGrath, Nuala
  • Sartorius, Benn
  • Yapa, H. Manisha
  • Dobra, Adrian
  • Bärnighausen, Till
  • Tanser, Frank

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 increased 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.

Suggested Citation

  • Inghels, Maxime & Kim, Hae-Young & Mathenjwa, Thulile & Shahmanesh, Maryam & Seeley, Janet & Wyke, Sally & McGrath, Nuala & Sartorius, Benn & Yapa, H. Manisha & Dobra, Adrian & Bärnighausen, Till & Ta, 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 & Medicine, Elsevier, vol. 311(C).
    • Handle: RePEc:eee:socmed:v:311:y:2022:i:c:s0277953622006116
    DOI: 10.1016/j.socscimed.2022.115305
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953622006116
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.115305?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Obermeyer, C.M. & Osborn, M., 2007. "The utilization of testing and counseling for HIV: A review of the social and behavioral evidence," American Journal of Public Health, American Public Health Association, vol. 97(10), pages 1762-1774.
    2. Emma L Giles & Shannon Robalino & Elaine McColl & Falko F Sniehotta & Jean Adams, 2014. "The Effectiveness of Financial Incentives for Health Behaviour Change: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-16, March.
    3. Lumley, Thomas, 2004. "Analysis of Complex Survey Samples," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 9(i08).
    4. Yujin Lee & Dariush Mozaffarian & Stephen Sy & Yue Huang & Junxiu Liu & Parke E Wilde & Shafika Abrahams-Gessel & Thiago de Souza Veiga Jardim & Thomas A Gaziano & Renata Micha, 2019. "Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: A microsimulation study," PLOS Medicine, Public Library of Science, vol. 16(3), pages 1-20, March.
    5. Hyuncheol Bryant Kim & Beliyou Haile & Taewha Lee, 2017. "Promotion and Persistence of HIV Testing and HIV/AIDS Knowledge: Evidence From a Randomized Controlled Trial in Ethiopia," Health Economics, John Wiley & Sons, Ltd., vol. 26(11), pages 1394-1411, November.
    6. Shane Frederick & George Loewenstein & Ted O'Donoghue, 2002. "Time Discounting and Time Preference: A Critical Review," Journal of Economic Literature, American Economic Association, vol. 40(2), pages 351-401, June.
    7. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    8. Margaret L McNairy & Matthew R Lamb & Averie B Gachuhi & Harriet Nuwagaba-Biribonwoha & Sean Burke & Sikhathele Mazibuko & Velephi Okello & Peter Ehrenkranz & Ruben Sahabo & Wafaa M El-Sadr, 2017. "Effectiveness of a combination strategy for linkage and retention in adult HIV care in Swaziland: The Link4Health cluster randomized trial," PLOS Medicine, Public Library of Science, vol. 14(11), pages 1-20, November.
    9. Rebecca L. Thornton, 2008. "The Demand for, and Impact of, Learning HIV Status," American Economic Review, American Economic Association, vol. 98(5), pages 1829-1863, December.
    10. Ariel Tarasiuk & Gally Reznor & Sari Greenberg-Dotan & Haim Reuveni, 2012. "Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background," PLOS ONE, Public Library of Science, vol. 7(3), pages 1-7, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Leonard E Egede & Rebekah J Walker & Clara E Dismuke-Greer & Sarah Pyzyk & Aprill Z Dawson & Joni S Williams & Jennifer A Campbell, 2021. "Cost-effectiveness of financial incentives to improve glycemic control in adults with diabetes: A pilot randomized controlled trial," PLOS ONE, Public Library of Science, vol. 16(3), pages 1-11, March.
    2. Nava Ashraf & James Berry & Jesse M. Shapiro, 2010. "Can Higher Prices Stimulate Product Use? Evidence from a Field Experiment in Zambia," American Economic Review, American Economic Association, vol. 100(5), pages 2383-2413, December.
    3. Aaron Richterman & Harsha Thirumurthy, 2022. "The effects of cash transfer programmes on HIV-related outcomes in 42 countries from 1996 to 2019," Nature Human Behaviour, Nature, vol. 6(10), pages 1362-1371, October.
    4. Victoria Shelus & Jamilah Taylor & Elizabeth Greene & Jill Stanton & Allison Pack & Elizabeth E Tolley & Bernard M Branson & Wafaa M El-Sadr & June Pollydore & Theresa Gamble, 2018. "It’s all in the timing: Acceptability of a financial incentive intervention for linkage to HIV care in the HPTN 065 (TLC-Plus) study," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-16, February.
    5. Black, Samantha & Wallace, Melissa & Middelkoop, Keren & Robbertze, Dante & Bennie, Thola & Wood, Robin & Bekker, Linda-Gail, 2014. "Improving HIV testing amongst adolescents through an integrated Youth Centre rewards program: Insights from South Africa," Children and Youth Services Review, Elsevier, vol. 45(C), pages 98-105.
    6. Günther Fink & Peter C. Rockers, 2017. "Financial Incentives, Targeting, and Utilization of Child Health Services: Experimental Evidence from Zambia," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1307-1321, October.
    7. Kim, Younoh & Radoias, Vlad, 2016. "Education, individual time preferences, and asymptomatic disease detection," Social Science & Medicine, Elsevier, vol. 150(C), pages 15-22.
    8. Yang, Dean & Allen, James & Mahumane, Arlete & Riddell, James & Yu, Hang, 2023. "Knowledge, stigma, and HIV testing: An analysis of a widespread HIV/AIDS program," Journal of Development Economics, Elsevier, vol. 160(C).
    9. Finn McGuire & Noemi Kreif & Peter C. Smith, 2021. "The effect of distance on maternal institutional delivery choice: Evidence from Malawi," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2144-2167, September.
    10. Sterck Olivier, 2013. "Why are Testing Rates so Low in Sub-Saharan Africa? Misconceptions and Strategic Behaviors," Forum for Health Economics & Policy, De Gruyter, vol. 16(1), pages 219-257, September.
    11. Triyana, Margaret & White, Justin S., 2022. "Non-monetary incentives for tobacco prevention among youth in Indonesia," Journal of Health Economics, Elsevier, vol. 83(C).
    12. Angotti, Nicole & Bula, Agatha & Gaydosh, Lauren & Kimchi, Eitan Zeev & Thornton, Rebecca L. & Yeatman, Sara E., 2009. "Increasing the acceptability of HIV counseling and testing with three C's: Convenience, confidentiality and credibility," Social Science & Medicine, Elsevier, vol. 68(12), pages 2263-2270, June.
    13. Oster, Emily, 2012. "HIV and sexual behavior change: Why not Africa?," Journal of Health Economics, Elsevier, vol. 31(1), pages 35-49.
    14. Olivier STERCK, 2011. "Why only one individual tests for HIV/AIDS among Sub-Saharan African Couples?," LIDAM Discussion Papers IRES 2011024, Université catholique de Louvain, Institut de Recherches Economiques et Sociales (IRES).
    15. Teklewold, Hailemariam, 2011. "Farming or burning? shadow prices and farmer’s impatience on the allocation of multi-purpose resource in the mixed farming system of Ethiopia," 2011 International Congress, August 30-September 2, 2011, Zurich, Switzerland 116080, European Association of Agricultural Economists.
    16. van den Bergh, J.C.J.M. & Botzen, W.J.W., 2015. "Monetary valuation of the social cost of CO2 emissions: A critical survey," Ecological Economics, Elsevier, vol. 114(C), pages 33-46.
    17. Diane Coffey & Ashwini Deshpande & Jeffrey Hammer & Dean Spears, 2019. "Local Social Inequality, Economic Inequality, and Disparities in Child Height in India," Demography, Springer;Population Association of America (PAA), vol. 56(4), pages 1427-1452, August.
    18. Yao Yao, 2022. "Fertility and HIV Risk in Africa," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 45, pages 109-133, July.
    19. Robert Gazzale & Julian Jamison & Alexander Karlan & Dean Karlan, 2013. "Ambiguous Solicitation: Ambiguous Prescription," Economic Inquiry, Western Economic Association International, vol. 51(1), pages 1002-1011, January.
    20. Hinnosaar, Marit, 2016. "Time inconsistency and alcohol sales restrictions," European Economic Review, Elsevier, vol. 87(C), pages 108-131.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:311:y:2022:i:c:s0277953622006116. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.