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Comparative Effectiveness of Novel Nonmonetary Incentives to Promote HIV Testing: A Randomized Trial


Chamie, Gabriel; Schaffer, Elisabeth M.; Ndyabakira, Alex; Emperador, Devy M.; Kwarisiima, Dalsone; Camlin, Carol S.; Havlir, Diane V.; Kahn, James G.; Kamya, Moses R.; & Thirumurthy, Harsha (2018). Comparative Effectiveness of Novel Nonmonetary Incentives to Promote HIV Testing: A Randomized Trial. AIDS, 32(11), 1443-1451. PMCID: PMC6112858


OBJECTIVE: To assess the comparative effectiveness of alternative incentive-based interventions to promote HIV testing among men. DESIGN: Randomized clinical trial. METHODS: We enumerated four Ugandan parishes and enrolled men at least 18 years. Participants were randomized to six groups that received incentives of varying type and amount for HIV testing at a 13-day community health campaign. Incentive types were: gain-framed (control): participants were told they would receive a prize for testing; loss-framed: participants were told they had won a prize, shown several prizes, asked to select one, then told they would lose the prize if they did not test; lotteries: those who tested had a chance to win larger prizes. Each incentive type had a low and high amount (approximately US$1 and US$5/participant). The primary outcome was HIV-testing uptake at the community health campaign. RESULTS: Of 2532 participants, 1924 (76%) tested for HIV; 7.6% of those tested were HIV-positive. There was no significant difference in testing uptake in the two lottery groups (78%; P = 0.076) or two loss-framed groups (77%; P = 0.235) vs. two gain-framed groups (74%). Across incentive types, testing did not differ significantly in high-cost (76%) vs. low-cost (75%; P = 0.416) groups. Within low-cost groups, testing uptake was significantly higher in the lottery (80%) vs. gain-framed (72%; P = 0.009) group. CONCLUSION: Overall, neither offering incentives via lotteries nor framing incentives as losses resulted in significant increases in HIV testing compared with standard gain-framed incentives. However, when offering low-cost incentives to promote HIV testing, providing lottery-based rewards may be a better strategy than gain-framed incentives.


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Chamie, Gabriel
Schaffer, Elisabeth M.
Ndyabakira, Alex
Emperador, Devy M.
Kwarisiima, Dalsone
Camlin, Carol S.
Havlir, Diane V.
Kahn, James G.
Kamya, Moses R.
Thirumurthy, Harsha