Conditional Financial Incentives Increase Linkage to Care for Male Partners of Antenatal Clinic Attendees
Results of this study showed pronounced effects on testing without safety concerns from secondary distribution of HIV self-test kits.
HIV self-test kits combined with financial incentives may encourage men to attend the clinic for post-test HIV services, according to a study recently published in PLoS Medicine.
Men are underserved by current HIV testing services in settings with high HIV prevalence (like eastern and southern Africa) and remain a priority target population for many HIV policy makers. In the regions of eastern and southern Africa, only 52% of men living with HIV are aware of their infection and mortality related to AIDS-related illnesses is 27% higher in men compared with women. HIV self-test, where individuals collect their own sample (oral or blood), conduct the test, and interpret the result, has been found to be highly acceptable and has been shown to increase coverage and frequency of testing in high-risk men.
This study sought to identify interventions that could increase male partner testing and subsequent linkage with care or prevention by providing oral HIV self-test kits to a pregnant partner attending an antenatal care clinic. Antenatal services have achieved near-universal HIV testing among pregnant African women, which provides an ideal opportunity for engaging male partners. Therefore, this adaptive trial investigated the effect of HIV self-test alone or with additional interventions on the uptake of testing and linkage with care or prevention among male partners of antenatal care clinic attendees (ISRCTN 18421340).
In urban Blantyre, Malawi, between 2016 and 2017, women (n=2349) attending 1 of 3 antenatal care clinics for their current pregnancy and with a primary male partner not known to be on antiretroviral therapy were included. Participants were randomly assigned to either the standard of care (by means of a personalized invitation letter to the male partner to attend the clinic for HIV testing and receive posttest services) or 1 of 5 intervention arms. These were as follows: 1) women were provided with 2 HIV self-test kits for their partner; 2) women were provided with 2 HIV self-test kits for their partner along with a fixed financial incentive of $3; 3) women were provided with 2 HIV self-test kits for their partner along with a fixed financial incentive of $10; 4) women were provided with 2 HIV self-test kits for their partner and a 10% chance of receiving $30 in a lottery; and 5) women were provided 2 HIV self-test kits for their partner and a phone call reminder for the partner. The primary outcomes were the proportion of male partners who tested for HIV and linked into care or prevention within 28 days of the woman's enrollment, with referral for antiretroviral therapy or circumcision accordingly assuming 1 man per enrolled woman.
Results showed that male partner HIV testing increased when oral self-test kits were provided to men by a pregnant partner who was attending a clinic for antenatal care services. Compared with standard of care, male partner testing increased from 17% to approximately 87% to 95% with the oral self-test kits. Subsequent clinic attendance by male partners within 28 days of the participant's enrollment was 13.0% in the standard of care group, 17.5% in the 2 HIV self-test kits only arm, 40.9% in the 2 HIV self-test kits plus $3 arm, 51.7% in the 2 HIV self-test kits plus $10 arm, 18.6% in the 2 HIV self-test kits plus lottery arm, and 22.3% with the 2 HIV self-test kits plus phone call reminder arm.
Overall, the study authors concluded that, “In this study the odds of men's linkage to care or prevention increased substantially using conditional fixed financial incentives plus partner-delivered HIV self-test kits; combinations were potentially affordable.”
Choko AT, Corbett EL, Stallard N, et al. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. PLoS Med. 2019;16(1):e1002719.