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. 2018 Oct 3;8(10):e024310.
doi: 10.1136/bmjopen-2018-024310.

Financial Incentives to Increase Uptake of Pediatric HIV Testing (FIT): study protocol for a randomised controlled trial in Kenya

Anjuli D Wagner  1 , Irene N Njuguna  2   3 , Jillian Neary  1 , Vincent O Omondi  4 , Verlinda A Otieno  4 , Joseph Babigumira  1   5 , Elizabeth Maleche-Obimbo  6 , Dalton C Wamalwa  6 , Grace C John-Stewart  1   2   7   8 , Jennifer A Slyker  1   2
Affiliations

Financial Incentives to Increase Uptake of Pediatric HIV Testing (FIT): study protocol for a randomised controlled trial in Kenya

Anjuli D Wagner et al. BMJ Open. .

Abstract

Introduction: Index case testing (ICT) to identify HIV-infected children is efficient but has suboptimal uptake. Financial incentives (FI) have overcome financial barriers in other populations by offsetting direct and indirect costs. A pilot study found FI to be feasible for motivating paediatric ICT among HIV-infected female caregivers. This randomised trial will determine the effectiveness of FI to increase uptake of paediatric ICT.

Methods and analysis: The Financial Incentives to Increase Uptake of Pediatric HIV Testing trial is a five-arm, unblinded, randomised controlled trial that determines whether FI increases timely uptake of paediatric ICT. The trial will be conducted in multiple public health facilities in western Kenya. Each HIV-infected adult enrolled in HIV care will be screened for eligibility: primary caregiver to one or more children of unknown HIV status aged 0-12 years. Eligible caregivers will be individually randomised at the time of recruitment in equal 1:1:1:1:1 allocation to one of five arms (US$0 (control), US$1.25, US$2.50, US$5.00 and US$10.00). The trial aims to randomise 800 caregivers. Incentives will be disbursed at the time of child HIV testing using mobile money transfer or cash. Arms will be compared in terms of the proportion of adults who complete testing for at least one child within 2 months of randomisation and time to testing. A cost-effectiveness analysis of FI for paediatric ICT will also be conducted.

Ethics and dissemination: This study was reviewed and approved by the University of Washington Institutional Review Board and the Kenyatta National Hospital Ethics and Research Committee. Trial results will be disseminated to healthcare workers at study sites, regional and national policymakers, and with patient populations at study sites (regardless of enrolment in the trial). Randomised trials of caregiver-child FI interventions pose unique study design, ethical and operational challenges, detailed here as a resource for future investigations.

Trial registration number: NCT03049917; Pre-results.

Keywords: conditional cash transfer; financial incentive; index case testing; paediatric HIV testing; protocol.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Conceptual framework. Financial incentives (FI) may motivate caregivers who are willing to test to move to take action to test. However, they are unlikely to motivate caregivers who are unwilling to test to take action. Social services (SS) interventions may be needed to move those parents who are unwilling to test to take action.
Figure 2
Figure 2
Consolidated Standards of Reporting Trials (CONSORT) diagram.
Figure 3
Figure 3
Randomisation scratch card before randomisation arm reveal. FIT, Financial Incentives to Increase Uptake of Pediatric HIV Testing.
See this image and copyright information in PMC

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