Home-Based Intervention to Test and Start (HITS): a community-randomized controlled trial to increase HIV testing uptake among men in rural South Africa

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dc.contributor.authorFrank C Tanser
dc.contributor.authorHae-Young Kim
dc.contributor.authorThulile Mathenjwa
dc.contributor.authorMaryam Shahmanesh
dc.contributor.authorJanet Seeley
dc.contributor.authorPhillippa Matthews
dc.contributor.authorSally Wyke
dc.contributor.authorNuala McGrath
dc.contributor.authorOluwafemi Adeagbo
dc.contributor.authorBenn Sartorius
dc.contributor.authorHandurugamage Manisha Yapa
dc.contributor.authorThembelihle Zuma
dc.contributor.authorAnya Zeitlin
dc.contributor.authorAnn Blandford
dc.contributor.authorAdrian Dobra
dc.contributor.authorTill B€arnighausen
dc.date.accessioned2024-02-26T12:46:45Z
dc.date.available2024-02-26T12:46:45Z
dc.date.issued2020-12-23
dc.description.abstractIntroduction: The uptake of HIV testing and linkage to care remains low among men, contributing to high HIV incidence in women in South Africa. We conducted the “Home-Based Intervention to Test and Start” (HITS) in a 2x2 factorial cluster randomized controlled trial in one of the World’s largest ongoing HIV cohorts in rural South Africa aimed at enhancing both intrinsic and extrinsic motivations for HIV testing. Methods: Between February and December 2018, in the uMkhanyakude district of KwaZulu-Natal, we randomly assigned 45 communities (clusters) (n = 13,838 residents) to one of the four arms: (i) financial incentives for home-based HIV testing and linkage to care (R50 [$3] food voucher each); (ii) male-targeted HIV-specific decision support application, called EPIC-HIV; (iii) both financial incentives and male-targeted HIV-specific decision support application and (iv) standard of care (SoC). EPIC-HIV was developed to encourage and serve as an intrinsic motivator for HIV testing and linkage to care, and individually offered to men via a tablet device. Financial incentives were offered to both men and women. Here we report the effect of the interventions on uptake of home-based HIV testing among men. Intention-to-treat (ITT) analysis was performed using modified Poisson regression with adjustment for clustering of standard errors at the cluster levels. Results: Among all 13,838 men ≥ 15 years living in the 45 communities, the overall population coverage during a single round of home-based HIV testing was 20.7%. The uptake of HIV testing was 27.5% (683/2481) in the financial incentives arm, 17.1% (433/2534) in the EPIC-HIV arm, 26.8% (568/2120) in the arm receiving both interventions and 17.8% in the SoC arm. The probability of HIV testing increased substantially by 55% in the financial incentives arm (risk ratio (RR)=1.55, 95% CI: 1.31 to 1.82, p < 0.001) and 51% in the arm receiving both interventions (RR = 1.51, 95% CI: 1.21 to 1.87 p < 0.001), compared to men in the SoC arm. The probability of HIV testing did not significantly differ in the EPIC-HIV arm (RR = 0.96, 95% CI: 0.76 to 1.20, p = 0.70). Conclusions: The provision of a small financial incentive acted as a powerful extrinsic motivator substantially increasing the uptake of home-based HIV testing among men in rural South Africa. In contrast, the counselling and testing application which was designed to encourage and serve as an intrinsic motivator to test for HIV did not increase the uptake of home-based testing.
dc.description.librarianPM2023
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/37717
dc.language.isoen
dc.schoolPublic Health
dc.subject: Home-based HIV testing; men; financial incentives; counselling; mHealth; randomized controlled trial; South Africa
dc.titleHome-Based Intervention to Test and Start (HITS): a community-randomized controlled trial to increase HIV testing uptake among men in rural South Africa
dc.typeArticle
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