Abstract
BackgroundTo realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - micro-incentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women.Methods/designThis is a cluster randomized trial of 45 communities (clusters) in a rural area in the uMkhanyakude district of KwaZulu Natal, South Africa (2018–2021). The study is built upon the Africa Health Research Institute (AHRI)‘s HIV testing platform, which offers annual home-based rapid HIV testing to individuals aged 15 years and above. In a 2 × 2 factorial design, individuals aged ≥15 years living in the 45 clusters are randomly assigned to one of four arms: i) a financial micro-incentive (food voucher) (n = 8); ii) male-targeted HIV specific decision support (EPIC-HIV) (n = 8); iii) both the micro incentives and male-targeted decision support (n = 8); and iv) standard of care (n = 21). The EPIC-HIV application is developed and delivered via a tablet to encourage HIV testing and linkage to care among men. A mixed method approach is adopted to supplement the randomized control trial and meet the study aims.DiscussionThe findings of this trial will provide evidence on the feasibility and causal impact of two interventions - micro-incentives and a male-targeted HIV specific decision support - on uptake of home-based HIV testing, linkage to care, as well as population health outcomes including population viral load, HIV related mortality in men, and HIV incidence in young women (15-30 years of age).Trial registrationThis trial was registered on 28 November 2018 on, identifier https://clinicaltrials.gov/.
Highlights
To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of Human Immunodeficiency Virus (HIV) testing and HIV treatment among men to reduce the rate of HIV transmission to women
The key contributing factors are that men are less likely to test for HIV and far less likely to link to care if tested HIV positive [6], putting them at a greater risk of HIV-related death, as well as HIV transmission to their sexual partners
We hypothesize that provision of micro-incentives and male-targeted HIV-specific decision-support would enable people to make more informed choices and increase uptake of home-based HIV testing and linkage to care, leading to reduction in population viral load and HIV-related mortality among men and lower HIV incidence in young women
Summary
The HITS trial will provide evidence for the impact and feasibility of micro-incentives and a male-sensitive HIV specific decision-support application to increase uptake of home-based HIV testing and linkage to HIV care, so as to reduce HIV-related mortality in men and population-level HIV incidence in young women in the hyperendemic rural South African setting. Combination of quantitative and qualitative social science research produced from this study will be essential to understand the behavioural and social impact of offering micro-incentives and male-sensitive HIV specific decision support on the HIV care continuum and population-level health outcomes in this rural hyperendemic South African and other similar settings. Intervention delivery started in February 2018 and ended in December 2018. Participant follow-up will continue until the end of 2021.
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