Evaluating the Effectiveness of Incentives to Improve HIV Prevention Outcomes for Young Females in Eswatini: Sitakhela Likusasa Impact Evaluation Protocol and Baseline Results

Abstract

Background: Eswatini continues to have the highest prevalence of HIV in the world, and one of the highest HIV incidences among adult populations (aged 15-49). This analysis reports on both key elements of study design/protocol and baseline results from an impact evaluation of an intervention incentivizing (i) initiation, enrolment, attendance or completion of some form of education, and (ii) lower risk sexual behaviour. Methods: The impact evaluation employs a two by two factorial design in which participants are enrolled in either the incentive for education arm (‘education treatment arm’ providing a conditional cash incentive) or the control arm (‘education control arm’). In each of these arms, 50% of participants were randomized to also be eligible for selection – three times a year – to participate in a conditional raffle conditional on testing negative for curable STIs (syphilis and Trichomonas vaginalis). Results: Baseline recruitment and screening occurred in 2016 when a total of 6,055 individuals were screened of which 4,863 participated in the baseline survey, and 4,819 individuals were randomized into one of the study arms. The baseline prevalence of HIV, Trichomonas vaginalis, and syphilis among adolescent girls and young women 8.20% (397/4,840), 3.31% (150/4,533) and 0.17% (8/4,830) respectively. Conclusions: An educational cash incentive and raffle incentive impact evaluation that addresses adolescent girls and young women who are in-education and out-of-education has the potential to reduce HIV risk in adolescent girls and young women in Eswatini.Name of the registry: Pan African Clinical Trials RegistryTrial registration number: PACTR201811609257043Date of registration: May 11, 2018 ‘Retrospectively registered’URL of trial registry record: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=4685

Women of Worth: the impact of a cash plus intervention to enhance attendance and reduce sexual health risks for young women in Cape Town, South Africa

“…CTs with augmented HIV interventions in African AGYW have shown potential to lower HSV‐2, reduce HIV incidence to various degrees, reduce transactional sex and reduce HIV risk behaviours [ 24 , 47 , 48 , 49 , 50 , 51 ]. Within these programmes, CTs have been strongly associated with attendance and/or adherence with the study intervention [ 24 , 50 , 52 ].…”

“…These approaches aim to reduce individual, social and structural barriers to safe behaviours and enhanced access to services [ 15 ]. The effectiveness of CT alone on SRH/HIV outcomes in AGYW has been disappointing [ 16 , 17 ] “Cash plus” interventions have been recommended as they augment CTs with life skills, behavioural interventions (BIs) and health systems strengthening that could promote protective SRH behaviours, as well as access to quality services [ 15 , 16 , 18 , 19 , 20 ]…”

“…These approaches aim to reduce individual, social and structural barriers to safe behaviours and enhanced access to services [15]. The effectiveness of CT alone on SRH/HIV outcomes in AGYW has been disappointing [16,17] "Cash plus" interventions have been recommended as they augment CTs with life skills, behavioural interventions (BIs) and health systems strengthening that could promote protective SRH behaviours, as well as access to quality services [15,16,[18][19][20] A multi-phase, quasi-experimental study, Women of Worth (WoW), was conducted among 19-to 24-year-old women in Cape Town, SA as a component of an integrated, multicomponent, multi-sector intervention for young people (aged 10-24 years) funded by the Global Fund for Malaria, HIV and TB [21]. We hypothesized that a CT conditional on the attendance of a modular SRH/HIV skills building programme and the simultaneous strengthening of adolescent and youthfriendly services (AYFS) at public facilities would lead to reduction in risk factors and result in favourable SRH/HIV outcomes in this population.…”

Understanding reasons for low HIV testing services uptake among tertiary students in university in South Africa

“…Furthermore, the current study showed that only a few respondents supported the view that one should utilize HTS if becomes ill. Various motivations has been shown to increase uptake of HTS; however, studies evaluating the relationship between the use of financial incentives and uptake of HTS are limited [40,41].…”

Access to social protection by people living with, at risk of, or affected by HIV in Eswatini, Malawi, Tanzania and Zambia - results from Population-Based HIV Impact Assessments

“…Second, cash transfers are a primary delivery mechanism of social protection [7,24]. Because of their multiple impacts on health and development domains, cash transfers have heightened attention in HIV prevention and treatment efforts [15,16,18,25]. Third, children, adolescents, girls and women, people with disabilities, and older people, are often the focus populations of social protection programmes [7,24].…”