Effect of Non-Monetary Incentives on Uptake of Couples’ Counselling and Testing among Clients Attending Mobile HIV Services in Rural Zimbabwe: A Cluster-Randomised Trial

October 2017 - In Focus

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Sibanda, E.L., Tumushime, M., Mfuka, J., et al. The Lancet Global Health (September 2017), 5: e907-15.

This randomized controlled trial examined the uptake of mobile couples HIV testing and HIV diagnosis rates in 68 Zimbabwean communities, comparing participants who received USD$1.50 worth of grocery items and participants who did not receive incentives. In the intervention group, 55.7 percent of participants tested with a partner, compared to only 10 percent of testers in the control group. Intervention communities had higher HIV counseling and testing rates, and higher rates of HIV diagnosis, than control communities. Participants who tested with a partner were more likely than those testing alone to have an HIV-positive diagnosis. Post-intervention telephone interviews revealed that couples most often tested because they wanted to know their partner’s HIV status. Other reasons included planning for children and being nonmonogamous. Nearly 21 percent in the intervention group stated that they would not have tested with their partner without the grocery incentive. Harms from the intervention included feeling pressured or pressuring a partner to test, relationship unrest after a partner tested HIV positive—including one case of physical violence—separation/divorce, and regret about testing. However, the incidence of harm was low, reported by 1.2–2.1 percent of interviewees. Programs should consider using non-monetary incentives that are context-specific to increase couples’ testing rates.

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