Innovative Behavioral Economics Incentives Strategies for Health

Summary

The success of combination HIV prevention efforts, including HIV treatment as prevention, hinges on universal, routine HIV testing with effective treatment after HIV diagnosis. The proposed study will evaluate the comparative effectiveness and sustainability of innovative incentive strategies, informed directly by behavioral economics and decision psychology, to promote HIV testing among men and HIV treatment among HIV-infected adults in rural Uganda.

Conditions

• HIV/AIDS

Interventions

OTHER

Prize incentive - Low

Low expected prize value.

OTHER

Prize incentive - High

High expected prize value.

OTHER

Escalating payment incentive

The incentives will increase in value when participants are found to meet the pre-specified virologic suppression criteria at 6 weeks, 3 months and 6 months. If the virologic threshold for an incentive is missed at the 6 week or 3 month time-point, the subsequent incentive for an undetectable HIV viral load will be reset to the initial incentive value.

OTHER

Travel Voucher

Travel voucher to assist with linkage to care.

OTHER

Standard care

Includes HIV viral load and treatment adherence counseling.

BEHAVIORAL

Fixed Incentive - Prize

Men are informed that if they come for HIV testing, they will receive a specific prize (gain framing). The prize will be an item worth the same amount in US dollars as loss aversion and the expected value of a lottery prize. This gain-framed incentive resembles the form that incentives usually take in most studies and serves as a comparison to the lottery-based and loss-framed incentives.

BEHAVIORAL

Loss Aversion - Prize

The prizes are worth approximately the same amount as the fixed incentive and expected value of a lottery prize. At the time of randomization, study staff will inform the participant that he has won a prize. Staff will ask the participant to choose a specific prize from several choices, and then provide an opportunity for the participant to see the prize. Study staff will then tell participants that they will lose the prize if they do not participate in HIV testing. In this way, the incentive is framed as a loss rather than a gain, thereby leveraging loss aversion while not requiring men in very low-income settings to experience an actual loss.

BEHAVIORAL

Lottery - Prize

Men are entered in a lottery that offers a chance to win high-value prizes after testing for HIV at a community health campaign. Staff will emphasize that only those who come for HIV testing will be entered into the lottery and that not everyone will win a prize. Participants were informed at enrollment about the list of prizes and corresponding probabilities of winning them, in terms that are understandable to men with low numeracy (e.g., "1 in 20" rather than 5%). The probabilities of winning prizes varied between 1-5%, with higher value prizes having lower probability.

BEHAVIORAL

Fixed Incentive - Voucher

A standard gain-framed incentive arm in which participants will be offered a voucher for coming for a repeat HIV test in the future.

BEHAVIORAL

Loss Aversion - Deposit

A loss-aversion framed incentive in which participants will be asked to voluntarily make a deposit that can be retrieved, with interest on the deposit, if they come for an HIV test in the future (i.e. for repeat testing)

Sponsors & Collaborators

• University of Pennsylvania

  collaborator OTHER

• Makerere University

  collaborator OTHER

• National Institute of Mental Health (NIMH)

  collaborator NIH

• University of California, San Francisco

  lead OTHER

Principal Investigators

• Gabriel Chamie, MD, MPH · University of California, San Francisco

• Harsha Thirumurthy, PhD · University of Pennsylvania

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2016-04-30

Primary Completion

2019-08-21

Completion

2020-01-03

Countries

• Uganda

Study Locations