#IAS2017 | @IAS_conferenc Economic evaluation of nonfinancial incentives

#IAS2017 | @IAS_conferenc Economic evaluation of nonfinancial incentives

#IAS2017 | @IAS_conferenc Economic evaluation of nonfinancial incentives to increase Couples HIV Testing & Counselling uptake in Zimbabwe Mangenah C, Sibanda E, Hatzold K, Maringwa G, Mugurungi O, Terris-Prestholt F, Cowan FM, Thirumurthy H #IAS2017 | @IAS_conferenc #IAS2017 | @IAS_conferenc Presentation Outline Background global situation study setting #IAS2017 | @IAS_conferenc Presentation Outline Background

global situation study setting Methodology cluster-RCT Trial design cost analysis #IAS2017 | @IAS_conferenc Presentation Outline Background global situation study setting Methodology cluster-RCT Trial design cost analysis Results cost analysis incremental cost analysis

#IAS2017 | @IAS_conferenc Presentation Outline Background global situation study setting Methodology cluster-RCT Trial design cost analysis Results cost analysis incremental cost analysis Conclusions #IAS2017 | @IAS_conferenc Background - Global situation 2012 WHO HIV testing guidance recommends HIV Testing & Counseling Services for couples

(CHTC) joint status disclosure & trained counsellor support higher uptake of prevention, treatment & support #IAS2017 | @IAS_conferenc Background - Global situation 2012 WHO HIV testing guidance recommends HIV Testing & Counseling Services for couples (CHTC) CHTC uptake remains sub-optimal despite multiple HIV prevention benefits Only 30% of people seeking HIV testing take up CHTC #IAS2017 | @IAS_conferenc Background - Global situation 2012 WHO HIV testing guidance recommends HIV Testing & Counseling Services for couples

(CHTC) CHTC uptake remains sub-optimal despite multiple HIV prevention benefits fears around relationship instability/dissolution revelation of undisclosed sexual behaviour clients discount longer-term CHTC benefits even if > testing alone #IAS2017 | @IAS_conferenc Background - Study Setting Zimbabwes prevalence = 14% Generalised HIV epidemic CHTC uptake remains low (7%) along with rest of Southern Africa South Africa = 5% Mozambique = 12% Swaziland = 2% Zambia = 24 #IAS2017 | @IAS_conferenc

Background - Study Setting Zimbabwes prevalence = 14% Generalised HIV epidemic CHTC uptake remains low (7%) Despite extensive mobile testing + community mobilisation visits #IAS2017 | @IAS_conferenc Background - Study Setting Zimbabwes prevalence = 14% Generalised HIV epidemic CHTC uptake remains low (7%) Low cost strategies for increasing uptake are clearly necessary Zimbabwe LICs #IAS2017 | @IAS_conferenc

Methodology Cluster RCT trial design Lancet Global Health in press Cluster-RCT measuring impact of incentives on CHTC uptake n=68 rural community clusters n=4 rural Zimbabwe districts Small non-financial incentives can increase CHTC uptake counteract present-biased preferences focus on incentives vs costs Clients randomized incentives for CHTC (1 of 3 grocery items worth US$1.50) (bar of laundry soap, petroleum jelly, cooking oil) standard mobilization #IAS2017 | @IAS_conferenc

Methodology cost analysis Measure of value Perspective Outcomes Data types Amortization period Exchange rate Incremental costs of incentive arm over standard mobilisation arm Provider/implementer perspective Cost ($)/ individual client tested with a partner Cost ($)/ individual tested, Cost ($)/ HIV diagnosis Actual purchase prices from provider

Quantity & cost (incentives, HR, equipment, HIV test kits, stationary & other supplies Between 3 & 10 years US$1 = US$1(US$ is principal currency in Zim post 2009) #IAS2017 | @IAS_conferenc Results cluster RCT Lancet Global Health in press Outcome Outreach-team days Number tested & counselled Number tested/day No incentive arm (n=34)

Incentive arm (n=34) 195 214 10,839 14,932 56 (95% CI 50-62) 70 (95% CI 62-77) Couple testers 1062 (10.0%) OR=1 HIV prevalence

Yield per day Male testers 676 (6.5%) 3.5 (2.8-4.2) 4892 (46.2) 7852 (55.7%) OR=13.5 (10.5 17.4) 1206 (8.8%) 5.6 (4.8-6.5) 6377 (45.2) #IAS2017 | @IAS_conferenc Results - cost analysis Cost category Incentives HR Equipment Medical

supplies HIV test kits Other supplies Total cost ($) No incentive Contributi Incentive Contributi ($) on ($) on

$0.00 0% $10,859.22 10% $69,423.75 80% $78,705.00 70% $1,154.95 1% $1,154.95

1% $1,919.76 2% $2,541.42 2% $1,537.96 2% $2,266.16 2% $12,556.78 15%

$16,753.95 15% $86,593.20 $112,280.7 0 # of clients 10,580 14,099 Cost/client $8.18 $7.96 #IAS2017 | @IAS_conferenc

Results Incremental cost analysis Intervention incremental cost (Incentive Standard mobilization) Intervention effect (incentive effects - nonincentive effects) Additional clients tested as a couple (14,099*46%) Additional clients tested HIV positive $25,687. 50 46% 6437 530 Incremental cost/client tested as a couple ($25,687.50/6437) $3.99 Incremental cost/client tested HIV positive

$48.47 #IAS2017 | @IAS_conferenc Conclusions Simple low-cost interventions to scale-up services close the tap on new infections Provision of non-financial incentives innovative strategy to increase CHTC uptake highly affordable Non-financial incentives for CHTC therefore highly recommended for policymakers & providers #IAS2017 | @IAS_conferenc Acknowledgements Partners Centre for Sexual Health, HIV & AIDS Research (CeSHHAR) Zimbabwe

Ministry of Health & Child Care (MoHCC) Zimbabwe Population Services International Zimbabwe London School of Hygiene and Tropical Medicine (LSHTM) University College London (UCL) Liverpool School of Tropical Medicine (LSTM) University of North Carolina at Chapel Hill (UNC-CH) #IAS2017 | @IAS_conferenc Acknowledgements Partners Centre for Sexual Health, HIV & AIDS Research (CeSHHAR) Zimbabwe Ministry of Health & Child Care

(MoHCC) Zimbabwe Population Services International Zimbabwe London School of Hygiene and Tropical Medicine (LSHTM) University College London (UCL) Liverpool School of Tropical Medicine (LSTM) University of North Carolina at Chapel Hill (UNC-CH) Funding Zimbabwes ISP ISP contributors (DFID, SIDA, Irish AID), through PSI Zimbabwe #IAS2017 | @IAS_conferenc Acknowledgements Partners

Centre for Sexual Health, HIV & AIDS Research (CeSHHAR) Zimbabwe Ministry of Health & Child Care (MoHCC) Zimbabwe Population Services International Zimbabwe London School of Hygiene and Tropical Medicine (LSHTM) University College London (UCL) Liverpool School of Tropical Medicine (LSTM) University of North Carolina at Chapel Hill (UNC-CH) Funding Zimbabwes ISP

ISP contributors (DFID, SIDA, Irish AID), through PSI Zimbabwe Ethical approval Medical Research Council of Zimbabwe (MRCZ) University College London (UCL) Ethics Committee Trial registration - Pan African Clinical Trial Registry, PACTR201606001630356 #IAS2017 | @IAS_conferenc Thank you Questions? Comments? Contact Collin Mangenah Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe +263774094023 [email protected]

[email protected] Skype: Collin.mangenah1

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