title: Do gifts increase consent to home-based HIV testing? A difference-in-differences study in rural KwaZulu-Natal, South Africa.
abstract: Despite the importance of HIV testing for controlling the HIV epidemic, testing rates remain low. Efforts to scale up testing coverage and frequency in hard-to-reach and at-risk populations commonly focus on home-based HIV testing. This study evaluates the effect of a gift (a US$5 food voucher for families) on consent rates for home-based HIV testing.
  
  
  
  We use data on 18 478 individuals (6 418 men and 12 060 women) who were successfully contacted to participate in the 2009 and 2010 population-based HIV surveillance carried out by the Wellcome Trust's Africa Health Research Institute in rural KwaZulu-Natal, South Africa. Of 18 478 potential participants contacted in both years, 35% (6 518) consented to test in 2009, and 41% (7 533) consented to test in 2010. Our quasi-experimental difference-in-differences approach controls for unobserved confounding in estimating the causal effect of the intervention on HIV-testing consent rates.
  
  
  
  Allocation of the gift to a family in 2010 increased the probability of family members consenting to test in the same year by 25 percentage points [95% confidence interval (CI) 21-30 percentage points; P  < 0.001]. The intervention effect persisted, slightly attenuated, in the year following the intervention (2011).
  
  
  
  In HIV hyperendemic settings, a gift can be highly effective at increasing consent rates for home-based HIV testing. Given the importance of HIV testing for treatment uptake and individual health, as well as for HIV treatment-as-prevention strategies and for monitoring the population impact of the HIV response, gifts should be considered as a supportive intervention for HIV-testing initiatives where consent rates have been low.
authors.affiliation: CHaRMS - Centre for Health Research at the Management School, Queen's University Belfast, Northern Ireland.|Africa Health Research Institute, Mtubatuba, South Africa.
authors.forename: Mark E
authors.initials: ME
authors.lastname: McGovern
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.
authors.forename: Kobus
authors.initials: K
authors.lastname: Herbst
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.|School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.
authors.forename: Tinofa
authors.initials: T
authors.lastname: Mutevedzi
authors.affiliation: Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston 02115, MA, USA.|Harvard Center for Population and Development Studies, Cambridge 02144, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Canning
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.
authors.forename: Dickman
authors.initials: D
authors.lastname: Gareta
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.affiliation: Africa Health Research Institute, Mtubatuba, South Africa.|Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston 02115, MA, USA.|Harvard Center for Population and Development Studies, Cambridge 02144, MA, USA.|Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Till
authors.initials: T
authors.lastname: Bärnighausen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D037921:Gift Giving; D015658:HIV Infections / Q000453:epidemiology*; D006699:Home Care Services; D006801:Humans; D007258:Informed Consent; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011159:Population Surveillance; D012424:Rural Population; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
keywords: difference-in-differences (DD) analysis; gift-voucher intervention; home-based HIV testing; rural South Africa