Evaluating the impact of conditional micro-incentives on linkage to HIV care in rural South Africa: results from the Home-Based Intervention to Test and Start (HITS) trial.
Hae-Young Kim, Maxime Inghels, Thulile Mathenjwa et al.
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In 30 seconds
The HITS real-world randomized trial assessed whether conditional food vouchers improved linkage to HIV care after home-based testing in rural KwaZulu-Natal, South Africa. Communities were assigned to voucher or non-incentive arms; vouchers were conditional on testing and linkage within 6 weeks. Among men, incentives did not significantly improve linkage within 6 weeks or at 1 year. Among women, linkage within 6 weeks increased (RR = 1.51; 95% CI: 1.03-2.21), but there was no residual effect at 1 year (RR = 1.07, 95% CI: 0.91-1.26).
Key findings
- Micro-incentives nearly doubled HIV-positive diagnoses overall.
- Among men, incentives did not increase linkage within 6 weeks (RR = 0.78, 95% CI: 0.51-1.21) or at 1 year (RR = 1.08, 95% CI: 0.86-1.35).
- Among women, incentives increased linkage within 6 weeks by 51% (RR = 1.51; 95% CI: 1.03-2.21), with no significant effect at 1 year (RR = 1.07, 95% CI: 0.91-1.26).
Why it matters
Linkage after diagnosis is essential for access to HIV treatment, yet incentives did not produce a consistent improvement across sex or follow-up period. The findings suggest that a one-off voucher may help women connect to care promptly while it is available, but does not establish sustained engagement or improved linkage among men. This distinction matters when evaluating incentive-based approaches to HIV testing and care.
What to keep in mind
The reported linkage effects were assessed over 1 year, and the intervention was a once-off incentive conditional on linkage within 6 weeks; longer-term effects are not established.