University of California, San Francisco, California, United States of America.
Infectious Diseases Research Collaboration, Mbarara, Uganda.
PLoS One. 2020 May 29;15(5):e0233600. doi: 10.1371/journal.pone.0233600. eCollection 2020.
Retesting for HIV is critical to identifying newly-infected persons and reinforcing prevention efforts among at-risk adults. Incentives can increase one-time HIV testing, but their role in promoting retesting is unknown. We sought to test feasibility and acceptability of incentive strategies, including commitment contracts, to promote HIV retesting among at-risk adults in rural Uganda.
At-risk HIV-negative adults were enrolled in a pilot trial assessing feasibility and acceptability of incentive strategies to promote HIV retesting three months after enrollment. Participants were randomized (1:1:3) to: 1) no incentive; 2) standard cash incentive (~US$4); and 3) commitment contract: participants could voluntarily make a low- or high-value deposit that would be returned with added interest (totaling ~US$4 including the deposit) upon retesting or lost if participants failed to retest. Contracts sought to promote retesting by leveraging loss aversion and addressing present bias via pre-commitment. Outcomes included acceptability of trial enrollment, contract feasibility (proportion of participants making deposits), and HIV retesting uptake.
Of 130 HIV-negative eligible adults, 123 (95%) enrolled and were randomized: 74 (60%) to commitment contracts, 25 (20%) to standard incentives, and 24 (20%) to no incentive. Of contract participants, 69 (93%) made deposits. Overall, 93 (76%) participants retested for HIV: uptake was highest in the standard incentive group (22/25 [88%]) and lowest in high-value contract (26/36 [72%]) and no incentive (17/24 [71%]) groups.
In a randomized trial of strategies to promote HIV retesting among at-risk adults in Uganda, incentive strategies, including commitment contracts, were feasible and had high acceptability. Our findings suggest use of incentives for HIV retesting merits further comparison in a larger trial.
ClinicalTrials.gov identifier: NCT:02890459.
对 HIV 进行复测对于发现新感染人群以及加强高危成年人的预防措施至关重要。激励措施可以增加一次性 HIV 检测，但它们在促进复测方面的作用尚不清楚。我们旨在测试激励策略（包括承诺合同）在促进乌干达农村高危成年人 HIV 复测方面的可行性和可接受性。
在一项评估激励策略促进 HIV 复测可行性和可接受性的试点试验中，招募了 HIV 阴性的高危成年人。参与者随机分为（1:1:3）：1）无激励；2）标准现金激励（约 4 美元）；3）承诺合同：参与者可以自愿存入低或高价值的押金，如果复测则退还并增加利息（包括押金共约 4 美元），如果参与者未复测则押金将被没收。合同旨在通过利用损失厌恶和通过预先承诺解决当前偏见来促进复测。结果包括试验参与的可接受性、合同可行性（参与存款的参与者比例）和 HIV 复测率。
在 130 名符合条件的 HIV 阴性成年人中，有 123 名（95%）参与并随机分组：74 名（60%）参加承诺合同组，25 名（20%）参加标准激励组，24 名（20%）参加无激励组。合同参与者中，有 69 名（93%）存入押金。总体而言，有 93 名（76%）参与者进行了 HIV 复测：标准激励组的复测率最高（22/25 [88%]），而高价值合同组（26/36 [72%]）和无激励组（17/24 [71%]）的复测率最低。
在乌干达高危成年人中促进 HIV 复测的策略随机试验中，激励策略（包括承诺合同）是可行的，且具有较高的可接受性。我们的研究结果表明，激励措施用于 HIV 复测值得在更大规模的试验中进一步比较。
ClinicalTrials.gov 标识符：NCT:02890459。
