Kim Hae-Young, Inghels Maxime, Mathenjwa Thulile, Shahmanesh Maryam, Seeley Janet, Matthews Phillippa, McGrath Nuala, Adeagbo Oluwafemi, Gareta Dickman, Yapa H Manisha, Zuma Thembelihle, Dobra Adrian, Bärnighausen Till, Tanser Frank
medRxiv. 2024 Mar 18:2024.03.15.24304278. doi: 10.1101/2024.03.15.24304278.
HIV elimination requires innovative approaches to ensure testing and immediate treatment provision. We investigated the effectiveness of conditional financial incentives on increasing linkage to HIV care in a 2×2 factorial cluster randomized controlled trial-Home-Based Intervention to Test and Start (HITS) - in rural South Africa.
Of 45 communities in uMkhanyakude, KwaZulu-Natal, 16 communities were randomly assigned to the arms to receive financial incentives for home-based HIV counseling and testing (HBHCT) and linkage to care within 6 weeks (R50 [US$3] food voucher each) and 29 communities to the arms without financial incentives. We examined linkage to care (i.e., initiation or resumption of antiretroviral therapy after >3 months of care interruption) at local clinics within 6 weeks of a home visit, the eligibility period to receive the second financial incentive. Linkage to care was ascertained from individual clinical records. Intention-to-treat analysis (ITT) was performed using modified Poisson regression with adjustment for receiving another intervention (i.e., male-targeted HIV-specific decision support app) and clustering of standard errors at the community level.
Among 13,894 eligible men (i.e., ≥15 years and resident in the 45 communities), 20.7% received HBHCT, which resulted in 122 HIV-positive tests. Of these, 27 linked to care within 6 weeks of HBHCT. Additionally, of eligible men who did not receive HBHCT, 66 linked to care. In the ITT analysis, the proportion of linkage to care among men did not differ in the arms which received financial incentives and those without financial incentives (adjusted Risk Ratio [aRR]=0.78, 95% CI: 0.51-1.21). Among 19,884 eligible women, 29.1% received HBHCT, which resulted in 375 HIV-positive tests. Of these, 75 linked to care. Among eligible women who did not receive HBHCT, 121 linked to care within 6 weeks. Women in the financial incentive arms had a significantly higher probability of linkage to care, compared to those in the arms without financial incentives (aRR=1.50; 95% CI: 1.03-2.21).
While a small once-off financial incentive did not increase linkage to care among men during the eligibility period of 6 weeks, it significantly improved linkage to care among women over the same period. Clinical Trial Number: ClinicalTrials.gov # NCT03757104.
消除艾滋病病毒需要创新方法来确保检测和及时提供治疗。我们在南非农村地区的一项2×2析因整群随机对照试验——居家检测与启动干预试验（HITS）中，研究了有条件的经济激励措施对增加艾滋病病毒治疗衔接率的有效性。
在夸祖鲁-纳塔尔省乌姆卡尼亚库德的45个社区中，16个社区被随机分配到接受居家艾滋病病毒咨询检测（HBHCT）及在6周内实现治疗衔接的经济激励组（每组发放50兰特[3美元]食品券），29个社区被分配到无经济激励组。我们在居家访视后的6周内（即领取第二次经济激励的资格期），在当地诊所检查治疗衔接情况（即中断治疗超过3个月后开始或恢复抗逆转录病毒治疗）。治疗衔接情况通过个人临床记录确定。采用修正泊松回归进行意向性分析（ITT），并对接受的其他干预措施（即针对男性的艾滋病病毒特异性决策支持应用程序）及社区层面的标准误聚类进行调整。
在13894名符合条件的男性（即年龄≥15岁且居住在45个社区）中，20.7%接受了HBHCT，检测出122例艾滋病病毒阳性。其中，27例在HBHCT后的6周内实现了治疗衔接。此外，在未接受HBHCT的符合条件男性中，有66例实现了治疗衔接。在ITT分析中，接受经济激励组和未接受经济激励组的男性治疗衔接比例没有差异（调整风险比[aRR]=0.78，95%置信区间：0.51 - 1.21）。在19884名符合条件的女性中，29.1%接受了HBHCT，检测出375例艾滋病病毒阳性。其中，75例在6周内实现了治疗衔接。在未接受HBHCT的符合条件女性中，有121例在6周内实现了治疗衔接。与未接受经济激励组的女性相比，接受经济激励组的女性实现治疗衔接的概率显著更高（aRR=1.50；95%置信区间：1.03 - 2.21）。
虽然一次性小额经济激励措施在6周的资格期内未提高男性的治疗衔接率，但在同一时期显著改善了女性的治疗衔接率。临床试验编号：ClinicalTrials.gov # NCT03757104。
