Do financial incentives promote HIV testing in pregnant women?

Which is better at improving HIV testing rates among pregnant women in a high-HIV burden setting in Ecuador: giving the women printed information about HIV and testing, giving them information and nudging them to get tested or providing them with a financial incentive?

That’s a question Dr. Miguel Reina Ortiz, a USF College of Public Health (COPH) associate professor, COPH colleague Dr. Ricardo Izurieta and others from around the country and Ecuador set out to answer.

Knowing one’s HIV status is an important first step in preventing HIV transmission, including mother-to-baby transmission. But barriers to HIV testing exist, including lack of access to testing, stigma and fear of positive test results.

The Study

Noting that behavioral nudging and financial incentives can lead to higher positive testing rates among the general public, the researchers decided to look exclusively at pregnant women. 

Over 400 pregnant women in the study were separated into three treatment groups. 

The Findings

The odds of getting tested were 17 times higher among those in the financial incentive group than those in the information-only group. Conversely, those in the behavioral nudging group were seven times less likely to get tested when compared to the information-only group.

“There are several factors that may explain why, in this particular setting, financial incentives were a better motivator than behavioral nudges in promoting HIV testing,” said Reina Ortiz, who is an alum of the college. “We know that there are psychosocial and economic barriers for HIV testing in certain population groups. In those circumstances, financial incentives may help offset the relative costs of HIV testing. In addition, many of the women in our target population had already been tested either due to their current or previous pregnancies or because they had been required to do so as a university requirement. In both cases, previous HIV testing (with known results) may have eliminated the perceived ‘need’ for a new HIV test. That being said, our research did lead to new HIV diagnoses, which proves the usefulness of complementary approaches to improve HIV testing among pregnant women, especially to capture those women who may have not been reached by the programs in place.”

The Upshot

Reina Ortiz acknowledged that while motivating health behaviors with financial incentives isn’t always feasible, it can be effective, especially with the appropriate political commitment.

“Our previous research has shown a cost-benefit analysis in favor of the intervention,” he noted. “In the long run, for the case we studied, the cost of financial incentives would be lower than not implementing them. But before scaling up an intervention like this, a cost-benefit analysis should be conducted.”

According to Reina Ortiz, more research is needed before making any definitive conclusions about using financial incentives as a motivator to change health behaviors.

“The results of this study cannot necessarily be extrapolated to similar populations in other cities of Ecuador or, even, the U.S.,” Reina Ortiz said. “The contribution, though, is significant as it shows that financial incentives may be useful. New research should be conducted in other areas to evaluate whether similar results are achieved. It may be, for instance, that in other cities behavioral nudges do lead to more HIV testing.”

The research, “Financial incentives, not behavioral nudges, optimize HIV testing among pregnant women in a highly Afro-descendant, high-HIV burden urban population,” will be published in the American Journal of Tropical Medicine and Hygiene.

Story by Donna Campisano, USF College of Public Health