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Lottery incentives have short-term impact on ART initiation among men: results from a randomized pilot study

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dc.date.accessioned 2020-07-27T12:15:06Z
dc.date.available 2020-07-27T12:15:06Z
dc.date.issued 2020-07-27 en
dc.identifier.uri http://hdl.handle.net/20.500.11910/15355
dc.description.abstract Introduction: Among people living with HIV in South Africa, viral suppression is lower among men than women. The study aim was to test the impact of lottery incentives, which reward positive health choice (e.g. antiretroviral therapy (ART) linkage) with a chance to win a prize, on strengthening the HIV care continuum including ART initiation and viral suppression for men. Methods: We conducted a randomized, prospective trial of lottery incentives in the context of HIV testing and linkage to ART in rural KwaZulu-Natal, South Africa. Men living with HIV were randomly allocated to: lottery incentives and motivational text messages or motivational text messages only. Lottery prize eligibility was conditional on clinic registration, ART initiation, or viral suppression by one, three and six months respectively. After completing each continuum step, participants in the lottery group were notified whether they had won and were encouraged to continue in care. Lottery prizes were either a mobile phone, data or a gift card (valued at R1000/$100). Kaplan Meier curves were plotted to determine time to ART initiation by study group. The primary outcome was viral suppression at six months. Results: Between November 2017 and December 2018, we tested 740 men for HIV and enrolled 131 HIV-positive men who reported not being on ART. At baseline, 100 (76%) participants were 30 years and older, 95 (73%) were unemployed and the median CD4 count was 472 cells/lL. At study exit, 84% (110/131) of participants had visited a clinic and 62% (81/131) were virally suppressed. Compared to motivational text messages, lottery incentives decreased the median time to ART initiation from 126 to 66 days (p = 0.0043, age-adjusted Cox regression) among all participants, and, from 134 days to 20 days (p = 0.0077) among participants who were not virally suppressed at baseline. Lottery incentives had an inconclusive effect on clinic registration (RR = 1.21, 95% CI: 0.83 to 1.76) and on viral suppression at six months (RR = 1.13, 95% CI: 0.73 to 1.75) compared to motivational text messages. Conclusions: Conditional lottery incentives shortened the time to ART initiation among South African men. Behavioural economics strategies strengthen linkage to ART, but the study power was limited to see an impact on viral suppression. en
dc.format.medium Print en
dc.publisher Wiley Publishing Company en
dc.subject HIV/AIDS en
dc.subject SOUTH AFRICA en
dc.subject MEN en
dc.subject LOTTERIES en
dc.subject INCENTIVES en
dc.title Lottery incentives have short-term impact on ART initiation among men: results from a randomized pilot study en
dc.type Journal Article en
dc.description.version Y en
dc.ProjectNumber SOANAA en
dc.Volume 23(S2) en
dc.BudgetYear 2020/21 en
dc.ResearchGroup Human and Social Capabilities en
dc.ResearchGroup Impact Centre en
dc.SourceTitle Journal of the International AIDS Society en
dc.ArchiveNumber 11424 en
dc.PageNumber 43-50 en
dc.outputnumber 10604 en
dc.bibliographictitle Barnabas, R.V., Van Heerden, A., McConnell, M., Szpiro, A.A., Krows, M.L., Schaafsma, T.T., Ngubane, T., Nxele, R.B., Joseph, P., Baeten, J.M., Celum, C.L. & Van Rooyen, H. (2020) Lottery incentives have short-term impact on ART initiation among men: results from a randomized pilot study. <i>Journal of the International AIDS Society</i>. 23(S2):43-50. en
dc.publicationyear 2020 en
dc.contributor.author1 Barnabas, R.V. en
dc.contributor.author2 Van Heerden, A. en
dc.contributor.author3 McConnell, M. en
dc.contributor.author4 Szpiro, A.A. en
dc.contributor.author5 Krows, M.L. en
dc.contributor.author6 Schaafsma, T.T. en
dc.contributor.author7 Ngubane, T. en
dc.contributor.author8 Nxele, R.B. en
dc.contributor.author9 Joseph, P. en
dc.contributor.author10 Baeten, J.M. en
dc.contributor.author11 Celum, C.L. en
dc.contributor.author12 Van Rooyen, H. en

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