Balampama Marianna, de Walque Damien, Dow William H, Hémono Rebecca
Independent Scholar, Dar-Es-Salaam, Tanzania.
Development Research Group, The World Bank, Washington, DC, 20433, USA.
AIDS Behav. 2025 Sep 1. doi: 10.1007/s10461-025-04822-8.
Female sex workers (FSW) are a key population who experience a disproportionately high burden of HIV and sexually transmitted infections (STIs). A growing body of evidence suggests that financial incentives can reduce risky sexual behavior and reduce HIV/STI incidence, however few studies have examined a lottery-based incentive mechanism or been conducted with FSW. We examined the effect of a lottery intervention on combined HIV/HSV2 incidence among FSW. The RESPECT II trial was an unmasked, two-arm, parallel group randomized controlled trial conducted in Dar es Salaam, Tanzania (AEA RCT registry: AEARCTR-0002677). Individuals who were ≥ 18 years of age, HIV-negative, not currently pregnant, exchanged sex for money in the past six months, and living in Dar es Salaam were eligible. Participants were randomized in a 1:1 ratio to the basic test group (control) which included testing and counseling for HIV and biweekly text messages with information on safe sex practices, or to the lottery group, which provided the basic test group intervention plus entry into a weekly lottery with a 100,000 TZS (~ $50 USD) reward offered to ten randomly selected participants, conditional on negative test results for syphilis and trichomonas. The primary outcome was combined HIV/HSV2 incidence after 36 months. Between August 2018-February 2019, 2,489 individuals screened for eligibility and 2,206 were enrolled in the trial and randomized. Participants were followed for up to 36 months; 1089 (49.4%) were lost to follow-up at endline and 1,117 were included in the primary intent to treat analysis (609 lottery, 508 control). At 36 months, there was no effect of the lottery intervention on the incidence of combined HIV/HSV2 (unadjusted RD: - 0.006, 95% CI - 0.05, 0.04; adjusted RD - 0.001, 95% CI - 0.05, 0.05). However, the results may have been affected by disruption from the COVID-19 pandemic, and unexpectedly high study attrition levels made it impossible to statistically rule out possible moderate-sized effects.
女性性工作者是感染艾滋病毒和性传播感染负担极高的重点人群。越来越多的证据表明，经济激励措施可以减少危险性行为并降低艾滋病毒/性传播感染的发病率，然而，很少有研究考察基于抽奖的激励机制，也很少有针对女性性工作者开展的此类研究。我们研究了抽奖干预对女性性工作者中艾滋病毒/单纯疱疹病毒2型合并感染发病率的影响。“尊重二号”试验是一项在坦桑尼亚达累斯萨拉姆进行的开放标签、双臂、平行组随机对照试验（AEA随机对照试验注册编号：AEARCTR-0002677）。年龄≥18岁、艾滋病毒检测呈阴性、目前未怀孕、在过去六个月内有金钱交易性行为且居住在达累斯萨拉姆的个体符合条件。参与者按1:1的比例随机分为基础检测组（对照组），该组包括艾滋病毒检测和咨询以及关于安全性行为信息的双周短信提醒；或抽奖组，该组除提供基础检测组的干预措施外，还可参与每周一次的抽奖，若梅毒和滴虫检测结果为阴性，随机抽取十名参与者可获得100,000坦桑尼亚先令（约50美元）的奖励。主要结局是36个月后的艾滋病毒/单纯疱疹病毒2型合并感染发病率。在2018年8月至2019年2月期间，2489人接受了资格筛查，2206人被纳入试验并随机分组。对参与者进行了长达36个月的随访；在终期随访时，1089人（49.4%）失访，1117人被纳入主要意向性分析（609人在抽奖组，508人在对照组）。在36个月时，抽奖干预对艾滋病毒/单纯疱疹病毒2型合并感染发病率没有影响（未调整的风险差：-0.006，95%置信区间-0.05，0.04；调整后的风险差-0.001，95%置信区间-0.05，0.05）。然而，结果可能受到了新冠疫情干扰的影响，且意外的高失访率使得无法从统计学上排除可能存在的中等效应。
