CIPHER Project

The CIPHER grant is used solely for the purpose of funding the approved research project of “Financial incentives to increase pediatric HIV testing”. Phase one funding period is from August 2015 to July 2018

Financial incentives (FI) is a novel approach to motivate parents to test their HIV-exposed children promptly. FI has been used to motivate a wide variety of health behaviors, including adult HIV testing and anti-retroviral therapy (ART) adherence. Our proposal aims to evaluate the efficacy and cost-effectiveness of FI to motivate pediatric HIV testing in a randomized clinical trial in Kenya.

Purpose

Despite encouraging parents to test older children for HIV, most of the world’s 3.2 million HIV-infected children are diagnosed only when hospitalized or severely ill, after which they have extremely high mortality. Early initiation of HIV treatment in children decreases mortality substantially, but children lag adults in HIV treatment, ART-eligible children a third less likely to be on treatment compared to adults. Infants are systematically tested in prevention of mother-to-child HIV transmission (PMTCT) programs, but there are no effective systems to systematically test older children until they are ill. In a previous study we found that systematically asking HIV-infected parents to test their children increased testing 4-fold, however, 86% of parents still did not complete testing. New approaches are therefore needed to motivate parents to test their HIV-exposed children. Offering small financial incentives may motivate parents to test their children earlier and therefore improve outcomes of HIV treatment.

In this study we proposed to test whether small financial incentives motivate parents to test their children for HIV. The study had 2 phases; a pilot phase where we aimed to determine incentive levels and a trial phase to test effectiveness of this intervention.

Aim of the project:

  1. To determine whether offering small financial incentives increases uptake of pediatric HIV testing among HIV-infected parents. To compare the proportion of children tested between parents randomized to no incentive versus 3 different levels of financial incentive.
  2. To evaluate the cost-effectiveness of financially incentivizing pediatric HIV testing in Kenya.
  3. To determine the most cost-effective incentive value for the population under study. We will use cost-effectiveness analysis to determine the incremental cost effectiveness ratio (ICER) comparing standard targeted pediatric HIV testing to three levels of incentivized targeted pediatric HIV testing.
  4. To model the cost-utility of small FI in diverse areas and populations with varying underlying infection prevalence. We will conduct a cost-utility analysis to compare the cost per disability adjusted life year (DALY) averted between standard targeted pediatric HIV testing and three levels of incentivized targeted pediatric HIV testing in areas with varying underlying infection prevalence, age, PMTCT coverage, uptake of testing, health care costs, transport costs, and patient wages.