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Comparative effectiveness of novel nonmonetary incentives to promote HIV testing

Chamie, Gabriela; Schaffer, Elisabeth M.b; Ndyabakira, Alexc; Emperador, Devy M.a; Kwarisiima, Dalsoned; Camlin, Carol S.a; Havlir, Diane V.a; Kahn, James G.a; Kamya, Moses R.e; Thirumurthy, Harshaf

doi: 10.1097/QAD.0000000000001833

Objective: To assess the comparative effectiveness of alternative incentive-based interventions to promote HIV testing among men.

Design: Randomized clinical trial.

Methods: We enumerated four Ugandan parishes and enrolled men at least 18 years. Participants were randomized to six groups that received incentives of varying type and amount for HIV testing at a 13-day community health campaign. Incentive types were: gain-framed (control): participants were told they would receive a prize for testing; loss-framed: participants were told they had won a prize, shown several prizes, asked to select one, then told they would lose the prize if they did not test; lotteries: those who tested had a chance to win larger prizes. Each incentive type had a low and high amount (∼US$1 and US$5/participant). The primary outcome was HIV-testing uptake at the community health campaign.

Results: Of 2532 participants, 1924 (76%) tested for HIV; 7.6% of those tested were HIV-positive. There was no significant difference in testing uptake in the two lottery groups (78%; P = 0.076) or two loss-framed groups (77%; P = 0.235) vs. two gain-framed groups (74%). Across incentive types, testing did not differ significantly in high-cost (76%) vs. low-cost (75%; P = 0.416) groups. Within low-cost groups, testing uptake was significantly higher in the lottery (80%) vs. gain-framed (72%; P = 0.009) group.

Conclusion: Overall, neither offering incentives via lotteries nor framing incentives as losses resulted in significant increases in HIV testing compared with standard gain-framed incentives. However, when offering low-cost incentives to promote HIV testing, providing lottery-based rewards may be a better strategy than gain-framed incentives.

aUniversity of California, San Francisco, California

bUniversity of North Carolina at Chapel Hill, North Carolina, USA

cMakerere University-UCSF Research Collaboration, Mbarara

dMakerere University Joint AIDS Program

eMakerere University College of Health Sciences, Kampala, Uganda

fUniversity of Pennsylvania, Philadelphia, Pennsylvania, USA.

Correspondence to Gabriel Chamie, MD, MPH, University of California, Box 0874, 995 Potrero Avenue, San Francisco, California, USA. Tel: +1 415 476 4082 x445; e-mail:

Received 13 December, 2017

Revised 13 March, 2018

Accepted 17 March, 2018

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