Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

T Mathenjwa; H-Y Kim; T Zuma; M Shahmanesh; J Seeley; P Matthews; S Wyke; N McGrath; B Sartorius; H M Yapa; O Adeagbo; A Blandford; A Dobra; T Bäernighausen; F Tanser

doi:10.1186/s12889-019-7277-0

Home-based intervention to test and start (HITS) protocol: a cluster-randomized controlled trial to reduce HIV-related mortality in men and HIV incidence in women through increased coverage of HIV treatment

BMC Public Health. 2019 Jul 19;19(1):969. doi: 10.1186/s12889-019-7277-0.

Authors

T Mathenjwa¹, H-Y Kim², T Zuma², M Shahmanesh^{2

3}, J Seeley^{2

4}, P Matthews², S Wyke⁵, N McGrath^{2

6}, B Sartorius⁷, H M Yapa^{2

8}, O Adeagbo^{2

9}, A Blandford¹⁰, A Dobra¹¹, T Bäernighausen¹², F Tanser^{2

13

14

15}

Affiliations

¹ Africa Health Research Institute, Durban, South Africa. tmathenjwa@ahri.org.
² Africa Health Research Institute, Durban, South Africa.
³ Institute for Global Health, University College London, London, United Kingdom.
⁴ London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁵ University of Glasgow, Glasgow, United Kingdom.
⁶ University of Southampton, Southampton, United Kingdom.
⁷ Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁸ The Kirby Institute, University of New South Wales, Sydney, Australia.
⁹ Department of Sociology, University of Johannesburg, Johannesburg, South Africa.
¹⁰ UCL Interaction Centre, University College London, London, United Kingdom.
¹¹ University of Washington, Washington, USA.
¹² University of Heidelberg, Heidelberg, Germany.
¹³ School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
¹⁴ Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
¹⁵ Research Department of Infection & Population Health, University College London, London, United Kingdom.

Abstract

Background: To realize the full benefits of treatment as prevention in many hyperendemic African contexts, there is an urgent need to increase uptake of HIV testing and HIV treatment among men to reduce the rate of HIV transmission to (particularly young) women. This trial aims to evaluate the effect of two interventions - micro-incentives and a tablet-based male-targeted HIV decision support application - on increasing home-based HIV testing and linkage to HIV care among men with the ultimate aim of reducing HIV-related mortality in men and HIV incidence in young women.

Methods/design: This is a cluster randomized trial of 45 communities (clusters) in a rural area in the uMkhanyakude district of KwaZulu Natal, South Africa (2018-2021). The study is built upon the Africa Health Research Institute (AHRI)'s HIV testing platform, which offers annual home-based rapid HIV testing to individuals aged 15 years and above. In a 2 × 2 factorial design, individuals aged ≥15 years living in the 45 clusters are randomly assigned to one of four arms: i) a financial micro-incentive (food voucher) (n = 8); ii) male-targeted HIV specific decision support (EPIC-HIV) (n = 8); iii) both the micro incentives and male-targeted decision support (n = 8); and iv) standard of care (n = 21). The EPIC-HIV application is developed and delivered via a tablet to encourage HIV testing and linkage to care among men. A mixed method approach is adopted to supplement the randomized control trial and meet the study aims.

Discussion: The findings of this trial will provide evidence on the feasibility and causal impact of two interventions - micro-incentives and a male-targeted HIV specific decision support - on uptake of home-based HIV testing, linkage to care, as well as population health outcomes including population viral load, HIV related mortality in men, and HIV incidence in young women (15-30 years of age).

Trial registration: This trial was registered on 28 November 2018 on, identifier https://clinicaltrials.gov/ .

Keywords: Counselling; Financial incentives; HIV; Home-based HIV testing; Linkage to care.

Publication types

Clinical Trial Protocol

MeSH terms

Adolescent
Adult
Cluster Analysis
Computers, Handheld
Decision Support Techniques*
Factor Analysis, Statistical
Female
HIV
HIV Infections / diagnosis*
HIV Infections / drug therapy
HIV Infections / epidemiology
Home Care Services*
Humans
Incidence
Male
Mass Screening / methods*
Middle Aged
Motivation*
Patient Acceptance of Health Care
Randomized Controlled Trials as Topic
South Africa / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding