Monetary incentives and peer referral in promoting secondary distribution of HIV self-testing among men who have sex with men in China: A randomized controlled trial

• DOI: 10.1371/journal.pmed.1003928
• Publication Date: 2022-02-14T19:01:14Z
• Authors: Yi Zhou; Ying Lu; Yuxin Ni; Dan Wu; Xi He; Jason J. Ong; Joseph D. Tucker; Sean Y. Sylvia; Fengshi Jing; Xiaofeng Li; Shanzi Huang; Guangquan Shen; Chen Xu; Yuan Xiong; Yongjie Sha; Mengyuan Cheng; Junjie Xu; Hongbo Jiang; Wencan Dai; Liqun Huang; Fei Zou; Cheng Wang; Bin Yang; Wenhua Mei; Weiming Tang
• Keywords: Adult; Male; China; R; HIV Infections; 16. Peace & justice; 796; 3. Good health; HIV Testing; Sexual and Gender Minorities; 03 medical and health sciences; Self-Testing; 0302 clinical medicine; Costs and Cost Analysis; Medicine; Humans; Homosexuality, Male; Reimbursement, Incentive; Research Article

Background Digital network–based methods may enhance peer distribution of HIV self-testing (HIVST) kits, but interventions that can optimize this approach are needed. We aimed to assess whether monetary incentives and referral could improve a secondary program for HIVST among men who have sex with (MSM) in China. Methods findings Between October 21, 2019 September 14, 2020, 3-arm randomized controlled, single-blinded trial was conducted online 309 individuals (defined as index participants) were assigned male at birth, aged 18 years or older, ever had male-to-male sex, willing order kits online, consented take surveys online. randomly participants into one the 3 arms: (1) standard (control) group ( n = 102); (2) (SD-M) 103); (3) plus (SD-M-PR) 104). Index groups encouraged distribute members within their social networks. Members received directly from through links MSM defined alters. 2 intervention receive fixed incentive ($3 USD) verified test result uploaded digital platform by each unique alter. SD-M-PR additionally personalized link alters Both needed pay refundable deposit ($15 ordering kit. All an 3-month follow-up survey after kits. The primary outcomes mean number motivated arm newly tested arm. These assessed using zero-inflated negative binomial regression determine differences participants. Analyses performed on intention-to-treat basis. also economic evaluation microcosting health provider perspective time horizon. 0.57 ± 0.96 (mean deviation [SD]) control group, compared 0.98 1.38 SD-M difference [MD] 0.41),and 1.78 2.05 (MD 1.21). 0.16 0.39 SD) 0.41 0.73 0.25) 0.91 0.41), respectively. Results indicated arms more likely motivate (control versus SD-M: incidence rate ratio [IRR 2.98, 95% CI 1.82 4.89, p -value < 0.001; SD-M-PR: IRR 3.26, 2.29 4.63, 0.001) 4.22, 1.93 9.23, 3.49, 1.92 6.37, conduct HIVST. proportion testers 28% 42% 32% group. A total (3 15 alters) positive, reactive rates similar between groups. costs $19,485.97 794 testers, including 450 344 alter testers. Overall, average cost per tester $24.54, $56.65. Monetary alone (SD-M group) cost-effective than (SD-M-PR terms alters, despite having larger effects. Compared $14.90 $16.61 For $24.65 $49.07 No study-related adverse events reported during study. Limitations include network might neglect lack internet access. Conclusions combined promote MSM. expand testing encouraging first-time This be expanded other public research, especially era Coronavirus Disease (COVID-19). Trial registration Chinese Clinical Registry (ChiCTR) ChiCTR1900025433