Economic strengthening for HIV testing and linkage to care: a review of the evidence

Abstract

Delayed HIV diagnosis and enrollment in HIV care can lead to negative health outcomes for individuals and pose major barriers to achieving the UNAIDS 90-90-90 treatment targets. Household economic strengthening (HES) initiatives are increasingly used to alleviate the direct and indirect costs of HIV testing and linkage to care for those who are diagnosed. The evidence linking HES with a range of HIV outcomes is growing, and this evidence review aimed to comprehensively synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search. Given the volume of evidence, the results are presented and discussed in three papers. This is the second paper in the series and focuses on the 20 studies on HIV testing, diagnosis, and enrollment in care. The results indicate that financial incentives are consistently and independently linked with higher testing uptake and yield among adults. Limited evidence indicates they may also be beneficial for enrollment in care. Evidence for other HES interventions is too sparse to identify clear trends.

Beyond the facility: An evaluation of seven community-based pediatric HIV testing strategies and linkage to care outcomes in a high prevalence, resource-limited setting

“…Most studies examining the impact of financial incentives on HTS coverage, linkage to care, and ART retention utilize conditional incentives. These show promising short-term effects, even with small amounts of money, while long-term effects are still largely unknown [ 45 , 46 ]. The majority of this literature focuses on investigating the use of financial incentives within HTS, with many studies consistently and independently linking it with a marked increase in the uptake of services [ 46 – 48 ].…”

“…A scarcity of research exists that investigates the impact of financial incentives on linkage to care and retention outcomes [46][47][48][49]. Within this research, a major challenge is posed by the limited comparability of studies [46]. This is primarily due to differences in study population and setting-spanning the urban United States [50], drug injection users in India [51], and cohorts in Sub-Saharan Africa [48,[53][54][55][56].…”

“…Inconsistent results were reported across studies providing limited generalizable evidence for implementors and policy makers. One of their few commonalities, also echoed in this paper, is the expressed need for further research that uncovers optimal models for financial incentives within linkage to care and retention interventions [46][47][48][49][50][51][52][53][54][55].…”

Economic compensation interventions to increase uptake of voluntary medical male circumcision for HIV prevention: A systematic review and meta-analysis

“…Zimbabwe Qualitative interviews and focus groups 17 interviews and 2 focus groups with coaches and 29 interviews with circumcised (n = 13) and uncircumcised boys (n = 16) ages [14][15][16][17][18][19] There were mixed reactions to the incentives. Some participants felt that incentives increased their motivation to go for VMMC.…”

“…These reviews generally found that such interventions may help to increase VMMC uptake, particularly when they address specific barriers, but evidence was limited. Economic compensation, or financial incentives, have been explored for a range of HIV-related behaviors, including sexual or drug use behaviors related to HIV prevention [12,13], HIV testing [12,14], linkage to or engagement in HIV treatment [10,12,14,15], and adherence to antiretroviral therapy [12,15,16]. These interventions occur within a broader social and health system context, where there may be economic incentives for other health-related behaviors (for example, prenatal care, infant vaccinations, or insecticide-treated bednets) [17].…”