ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
UNAIDS , 2014. Fast-track Ending the AIDS Epidemic by 2030. Available at: https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf. Accessed October 3, 2021.
-
2.
U.S. Department of Heatlh and Human Services , 2021. Ending the HIV Epidemic: About Ending the HIV Epidemic: Plan for America: Overview. Available at: https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Accessed October 3, 2021.
-
3.
Ministerio de Salud Pública del Ecuador, n.d. Estrategia Nacional de Salud Pública para VIH/SIDA-ITS. Available at: https://www.salud.gob.ec/programa-nacional-de-prevencion-y-control-de-vihsida-its/. Accessed October 3, 2021.
-
4.
Ministerio de Salud Pública del Ecuador , 2012 . Guía de Prevención y Control de la Transmisión Materno Infantil del VIH y Sífilis Congénita, y de Atención Integral de Niños/as con VIH/Sida. Available at: https://tinyurl.com/75uzzsfp. Accessed October 3, 2021.
-
5.
Sanchez-Gomez A et al.2014. HIV and syphilis infection in pregnant women in Ecuador: prevalence and characteristics of antenatal care. Sex Transm Infect 90: 70–75.
-
6.
Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M , 2010. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 20: 422–432.
-
7.
Atnafu Gebeyehu N, Yeshambel Wassie A, Abebe Gelaw K , 2019. Acceptance of HIV testing and associated factors among pregnant women attending antenatal care in Gunino Health Center, southern Ethiopia 2019: an institutional based cross-sectional study. HIV AIDS (Auckl) 11: 333–341.
-
8.
Pignatelli S et al.2006. Factors predicting uptake of voluntary counselling and testing in a real-life setting in a mother-and-child center in Ouagadougou, Burkina Faso. Trop Med Int Health 11: 350–357.
-
9.
Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K , 2020. Barriers to HIV testing uptake among men in sub-Saharan Africa: a scoping review. Afr J AIDS Res 19: 13–23.
-
10.
Centers for Disease Control and Prevention , 2020. HIV Testing. Available at: https://www.cdc.gov/hiv/testing/index.html. Accessed October 3, 2021.
-
11.
Goldberg J, Macis M, Chintagunta P , 2018. Incentivized Peer Referrals for Tuberculosis Screening: Evidence from India. Cambridge, MA: The National Bureau of Economic Research.
-
12.
Iajya V, Lacetera N, Macis M, Slonim R , 2013. The effects of information, social and financial incentives on voluntary undirected blood donations: evidence from a field experiment in Argentina. Soc Sci Med 98: 214–223.
-
13.
Grieco D, Lacetera N, Macis M, Di Martino D , 2018. Motivating cord blood donation with information and behavioral nudges. Sci Rep 8: 252.
-
14.
Macis M, Grunauer M, Gutierrez E, Izurieta R, Phan P, Reina Ortiz M, Rosas C, Teran E , 2021. Using incentives and nudging to improve non-targeted HIV testing in Ecuador: a randomized trial. AIDS Behav 25: 2542–2550.
-
15.
Ministerio de Salud Pública del Ecuador , 2017. Informe GAM Ecuador—Monitoreo Global del Sida 2017 | Ecuador 2017 UNAIDS UNGASS Progress Report. Available at: https://tinyurl.com/yw95j2jr. Accessed October 3, 2021.
-
16.
Hernandez I et al.2017. Risk factors associated with HIV among men who have sex with men (MSM) in Ecuador. Am J Men Health 11: 1331–1341.
-
17.
Hernandez I et al.2019. Risk factors for HIV and STI among female sex workers in a high HIV prevalent region of Ecuador. Cogent Med 6: 1565292.
-
18.
World Bank , 2021. PPP Conversion Factor, GDP (LCU per international $)—Ecuador. Available at: https://data.worldbank.org/indicator/PA.NUS.PPP?locations=EC. Accessed September 20, 2021.
-
19.
The Joint United Nations Programme on HIV/AIDS , 2019. Country Factsheets. Ecuador |2019. Available at: https://www.unaids.org/en/regionscountries/countries/ecuador. Accessed May 10, 2021.
-
20.
Calle Roldán J, Acuña C, Ríos P , 2017. Meìtodo de buìsqueda activa comunitaria para la captacioìn de gestantes y pueìrperas en Ecuador. Rev Panam Salud Publica 41: 1–6.
-
21.
Ministerio de Salud Pública del Ecuador , 2018. Boletín Anual VIH/sida y Expuestos Perinatales 2018. Available at: https://tinyurl.com/w76h6bck. Accessed October 3, 2021.
-
22.
Ministerio de Salud Pública del Ecuador , 2019. Boletín Anual VIH/sida y Expuestos Perinatales2019. Available at: https://tinyurl.com/4r25xs4t. Accessed October 3, 2021.
-
23.
López-Cevallos D, Chi C, Ortega F , 2014. Consideraciones para la transformación del sistema de salud del Ecuador desde una perspectiva de equidad. Rev Salud Publica (Bogota) 16: 346–359.
-
24.
Quizhpe E, Sebastian MS, Teran E, Pulkki-Brannstrom AM , 2020. Socio-economic inequalities in women’s access to health care: has Ecuadorian health reform been successful? Int J Equity Health 19: 178.
-
25.
Lopez-Cevallos D, Chi C , 2012. Inequity in health care utilization in Ecuador: an analysis of current issues and potential solutions. Int J Equity Health 11: A6–A6.
-
26.
Granda ML, Jimenez WG , 2019. The evolution of socio-economic health inequalities in Ecuador during a public health system reform (2006–2014). Int J Equity Health 18: 31.
-
27.
OPS , 2013. La salud de los Pueblos Indiìgenas y Afrodescendientes en Ameìrica Latina. Boletín Estadístico. Available at: https://tinyurl.com/4mt6w2we. Accessed October 3, 2021.
-
28.
Linnemayr S, Stecher C, Saya U, MacCarthy S, Wagner Z, Jennings L, Mukasa B , 2020. Behavioral Economics Incentives to Support HIV Treatment Adherence (BEST): protocol for a randomized controlled trial in Uganda. Trials 21: 9.
-
29.
Liu JX, Shen J, Wilson N, Janumpalli S, Stadler P, Padian N , 2019. Conditional cash transfers to prevent mother-to-child transmission in low facility-delivery settings: evidence from a randomised controlled trial in Nigeria. BMC Pregnancy Childbirth 19: 32.
-
30.
Galarraga O, Sosa-Rubi SG , 2019. Conditional economic incentives to improve HIV prevention and treatment in low-income and middle-income countries. Lancet HIV 6: e705–e714.
-
31.
Njuguna IN et al.2021. Financial incentives to increase pediatric HIV testing: a randomized trial. AIDS 35: 125–130.
-
32.
Ndyabakira A et al.2019. Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda. BMC Public Health 19: 1763.
-
33.
Choko AT et al.2019. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. PLoS Med 16: e1002719.
-
34.
Thomas R et al.2020. Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, east Zimbabwe: study protocol for a pilot randomised trial. Trials 21: 108.
-
35.
Chamie G, Ndyabakira A, Marson KG, Emperador DM, Kamya MR, Havlir DV, Kwarisiima D, Thirumurthy H , 2020. A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda. PLoS One 15: e0233600.
-
36.
Wagner Z, Montoy JCC, Drabo EF, Dow WH , 2020. Incentives versus defaults: cost-effectiveness of behavioral approaches for HIV screening. AIDS Behav 24: 379–386.
-
37.
Atkins D et al.2020. Use of the Consolidated Framework for Implementation Research (CFIR) to characterize healthcare workers’ perspectives on financial incentives to increase pediatric HIV testing. J Acquir Immune Defic Syndr.
-
38.
Brittain K, Mellins CA, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L , 2019. HIV-status disclosure and depression in the context of unintended pregnancy among South African women. Glob Public Health 14: 1087–1097.
-
39.
Watt MH, Knippler ET, Knettel BA, Sikkema KJ, Ciya N, Myer L, Joska JA , 2018. HIV disclosure among pregnant women initiating ART in Cape Town, South Africa: qualitative perspectives during the pregnancy and postpartum periods. AIDS Behav 22: 3945–3956.
-
40.
Bulterys MA et al.2021. Correlates of HIV status nondisclosure by pregnant women living with HIV to their male partners in Uganda: a cross-sectional study. J Acquir Immune Defic Syndr 86: 389–395.
-
41.
Duff P et al.2018. Realizing women living with HIV’s reproductive rights in the era of ART: the negative impact of non-consensual HIV disclosure on pregnancy decisions amongst women living with HIV in a Canadian setting. AIDS Behav 22: 2906–2915.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2706 | 384 | 36 |
| Full Text Views | 132 | 9 | 2 |
| PDF Downloads | 98 | 11 | 3 |
Financial Incentives, Not Behavioral Nudges, Led to Optimized HIV Testing among Pregnant Women in a High-Burden Urban Population in Ecuador
Miguel Reina Ortiz
Miguel Reina Ortiz
College of Public Health, University of South Florida, Tampa, Florida;
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Michelle Grunauer
Michelle Grunauer
Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador;
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Erika Gutierrez
Erika Gutierrez
Laboratorio Clínico Microlab Diagnostic, Esmeraldas, Ecuador;
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Ricardo Izurieta
Ricardo Izurieta
College of Public Health, University of South Florida, Tampa, Florida;
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Mario Macis
Mario Macis
Johns Hopkins Carey Business School, Baltimore, Maryland;
National Bureau of Economic Research, Cambridge, Maryland;
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National Bureau of Economic Research, Cambridge, Maryland;
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Phillip Phan
Phillip Phan
Johns Hopkins Carey Business School, Baltimore, Maryland;
Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
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Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
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Carlos Rosas
Carlos Rosas
Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador;
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Enrique Teran
Enrique Teran
Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador;
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ABSTRACT.
Behavioral economic principles are increasingly being used in the fight against HIV, including improving voluntary testing in sub-Saharan Africa and South America. However, behavioral nudges have not been widely tested as a strategy to optimize HIV testing in pregnant women. Here, we assessed whether behavioral nudges or financial incentives were effective in optimizing HIV testing among pregnant women in a high-HIV burden setting. A randomized clinical trial was conducted between May 21 and Oct 5, 2018, to allocate pregnant women in Ecuador into three study arms: information only, soft commitment (i.e., a behavioral nudge), and financial incentives. All participants received an informational flyer, including the address of a testing location. Participants in the soft-commitment arm signed and kept a form on which they committed to get tested for HIV. Those in the financial incentive arm received a $10 incentive when tested for HIV. A stepwise logistic regression analysis estimated the effect of the study arms on HIV testing rate. Participants in the financial-incentive arm had higher odds of getting an HIV test (adjusted odds ratio 17.06, P < 0.001) as compared with information-only participants. Soft-commitment had the opposite effect (adjusted odds ratio 0.14, P = 0.014). Financial incentives might be useful in improving HIV testing among pregnant women, especially among those who might be at higher risk but who have not completed an HIV test.
- Supplemental Materials (PDF 166 KB)
Author Notes
Financial support: This research was supported by the Creative and Novel Ideas in HIV Research (CNIHR) Program through a supplement to the University of Alabama at Birmingham (UAB) Center For AIDS Research funding (P30 AI027767). This funding was made possible by collaborative efforts of the Office of AIDS Research, the National Institute of Allergy and Infectious Diseases, and the International AIDS Society.
Authors’ addresses: Miguel Reina Ortiz and Ricardo Izurieta, College of Public Health, University of South Florida, Tampa, FL, E-mails: miguelreina@usf.edu and ricardoi@usf.edu. Michelle Grunauer and Carlos Rosas, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador, E-mails: mgrunauer@usfq.edu.ec and rcrvaxel@hotmail.com. Erika Gutierrez, Laboratorio Clínico Microlab Diagnostic, Esmeraldas, Ecuador, E-mail: microlab_diagnostic@hotmail.com. Mario Macis and Phillip Phan, Johns Hopkins Carey Business School, Baltimore, MD, E-mails: mmacis@jhu.edu and pphan@jhu.edu. Enrique Teran, Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador, E-mail: eteran@usfq.edu.ec.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
UNAIDS , 2014. Fast-track Ending the AIDS Epidemic by 2030. Available at: https://www.unaids.org/sites/default/files/media_asset/JC2686_WAD2014report_en.pdf. Accessed October 3, 2021.
-
2.
U.S. Department of Heatlh and Human Services , 2021. Ending the HIV Epidemic: About Ending the HIV Epidemic: Plan for America: Overview. Available at: https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/overview. Accessed October 3, 2021.
-
3.
Ministerio de Salud Pública del Ecuador, n.d. Estrategia Nacional de Salud Pública para VIH/SIDA-ITS. Available at: https://www.salud.gob.ec/programa-nacional-de-prevencion-y-control-de-vihsida-its/. Accessed October 3, 2021.
-
4.
Ministerio de Salud Pública del Ecuador , 2012 . Guía de Prevención y Control de la Transmisión Materno Infantil del VIH y Sífilis Congénita, y de Atención Integral de Niños/as con VIH/Sida. Available at: https://tinyurl.com/75uzzsfp. Accessed October 3, 2021.
-
5.
Sanchez-Gomez A et al.2014. HIV and syphilis infection in pregnant women in Ecuador: prevalence and characteristics of antenatal care. Sex Transm Infect 90: 70–75.
-
6.
Deblonde J, De Koker P, Hamers FF, Fontaine J, Luchters S, Temmerman M , 2010. Barriers to HIV testing in Europe: a systematic review. Eur J Public Health 20: 422–432.
-
7.
Atnafu Gebeyehu N, Yeshambel Wassie A, Abebe Gelaw K , 2019. Acceptance of HIV testing and associated factors among pregnant women attending antenatal care in Gunino Health Center, southern Ethiopia 2019: an institutional based cross-sectional study. HIV AIDS (Auckl) 11: 333–341.
-
8.
Pignatelli S et al.2006. Factors predicting uptake of voluntary counselling and testing in a real-life setting in a mother-and-child center in Ouagadougou, Burkina Faso. Trop Med Int Health 11: 350–357.
-
9.
Hlongwa M, Mashamba-Thompson T, Makhunga S, Hlongwana K , 2020. Barriers to HIV testing uptake among men in sub-Saharan Africa: a scoping review. Afr J AIDS Res 19: 13–23.
-
10.
Centers for Disease Control and Prevention , 2020. HIV Testing. Available at: https://www.cdc.gov/hiv/testing/index.html. Accessed October 3, 2021.
-
11.
Goldberg J, Macis M, Chintagunta P , 2018. Incentivized Peer Referrals for Tuberculosis Screening: Evidence from India. Cambridge, MA: The National Bureau of Economic Research.
-
12.
Iajya V, Lacetera N, Macis M, Slonim R , 2013. The effects of information, social and financial incentives on voluntary undirected blood donations: evidence from a field experiment in Argentina. Soc Sci Med 98: 214–223.
-
13.
Grieco D, Lacetera N, Macis M, Di Martino D , 2018. Motivating cord blood donation with information and behavioral nudges. Sci Rep 8: 252.
-
14.
Macis M, Grunauer M, Gutierrez E, Izurieta R, Phan P, Reina Ortiz M, Rosas C, Teran E , 2021. Using incentives and nudging to improve non-targeted HIV testing in Ecuador: a randomized trial. AIDS Behav 25: 2542–2550.
-
15.
Ministerio de Salud Pública del Ecuador , 2017. Informe GAM Ecuador—Monitoreo Global del Sida 2017 | Ecuador 2017 UNAIDS UNGASS Progress Report. Available at: https://tinyurl.com/yw95j2jr. Accessed October 3, 2021.
-
16.
Hernandez I et al.2017. Risk factors associated with HIV among men who have sex with men (MSM) in Ecuador. Am J Men Health 11: 1331–1341.
-
17.
Hernandez I et al.2019. Risk factors for HIV and STI among female sex workers in a high HIV prevalent region of Ecuador. Cogent Med 6: 1565292.
-
18.
World Bank , 2021. PPP Conversion Factor, GDP (LCU per international $)—Ecuador. Available at: https://data.worldbank.org/indicator/PA.NUS.PPP?locations=EC. Accessed September 20, 2021.
-
19.
The Joint United Nations Programme on HIV/AIDS , 2019. Country Factsheets. Ecuador |2019. Available at: https://www.unaids.org/en/regionscountries/countries/ecuador. Accessed May 10, 2021.
-
20.
Calle Roldán J, Acuña C, Ríos P , 2017. Meìtodo de buìsqueda activa comunitaria para la captacioìn de gestantes y pueìrperas en Ecuador. Rev Panam Salud Publica 41: 1–6.
-
21.
Ministerio de Salud Pública del Ecuador , 2018. Boletín Anual VIH/sida y Expuestos Perinatales 2018. Available at: https://tinyurl.com/w76h6bck. Accessed October 3, 2021.
-
22.
Ministerio de Salud Pública del Ecuador , 2019. Boletín Anual VIH/sida y Expuestos Perinatales2019. Available at: https://tinyurl.com/4r25xs4t. Accessed October 3, 2021.
-
23.
López-Cevallos D, Chi C, Ortega F , 2014. Consideraciones para la transformación del sistema de salud del Ecuador desde una perspectiva de equidad. Rev Salud Publica (Bogota) 16: 346–359.
-
24.
Quizhpe E, Sebastian MS, Teran E, Pulkki-Brannstrom AM , 2020. Socio-economic inequalities in women’s access to health care: has Ecuadorian health reform been successful? Int J Equity Health 19: 178.
-
25.
Lopez-Cevallos D, Chi C , 2012. Inequity in health care utilization in Ecuador: an analysis of current issues and potential solutions. Int J Equity Health 11: A6–A6.
-
26.
Granda ML, Jimenez WG , 2019. The evolution of socio-economic health inequalities in Ecuador during a public health system reform (2006–2014). Int J Equity Health 18: 31.
-
27.
OPS , 2013. La salud de los Pueblos Indiìgenas y Afrodescendientes en Ameìrica Latina. Boletín Estadístico. Available at: https://tinyurl.com/4mt6w2we. Accessed October 3, 2021.
-
28.
Linnemayr S, Stecher C, Saya U, MacCarthy S, Wagner Z, Jennings L, Mukasa B , 2020. Behavioral Economics Incentives to Support HIV Treatment Adherence (BEST): protocol for a randomized controlled trial in Uganda. Trials 21: 9.
-
29.
Liu JX, Shen J, Wilson N, Janumpalli S, Stadler P, Padian N , 2019. Conditional cash transfers to prevent mother-to-child transmission in low facility-delivery settings: evidence from a randomised controlled trial in Nigeria. BMC Pregnancy Childbirth 19: 32.
-
30.
Galarraga O, Sosa-Rubi SG , 2019. Conditional economic incentives to improve HIV prevention and treatment in low-income and middle-income countries. Lancet HIV 6: e705–e714.
-
31.
Njuguna IN et al.2021. Financial incentives to increase pediatric HIV testing: a randomized trial. AIDS 35: 125–130.
-
32.
Ndyabakira A et al.2019. Leveraging incentives to increase HIV testing uptake among men: qualitative insights from rural Uganda. BMC Public Health 19: 1763.
-
33.
Choko AT et al.2019. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. PLoS Med 16: e1002719.
-
34.
Thomas R et al.2020. Improving risk perception and uptake of voluntary medical male circumcision with peer-education sessions and incentives, in Manicaland, east Zimbabwe: study protocol for a pilot randomised trial. Trials 21: 108.
-
35.
Chamie G, Ndyabakira A, Marson KG, Emperador DM, Kamya MR, Havlir DV, Kwarisiima D, Thirumurthy H , 2020. A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda. PLoS One 15: e0233600.
-
36.
Wagner Z, Montoy JCC, Drabo EF, Dow WH , 2020. Incentives versus defaults: cost-effectiveness of behavioral approaches for HIV screening. AIDS Behav 24: 379–386.
-
37.
Atkins D et al.2020. Use of the Consolidated Framework for Implementation Research (CFIR) to characterize healthcare workers’ perspectives on financial incentives to increase pediatric HIV testing. J Acquir Immune Defic Syndr.
-
38.
Brittain K, Mellins CA, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L , 2019. HIV-status disclosure and depression in the context of unintended pregnancy among South African women. Glob Public Health 14: 1087–1097.
-
39.
Watt MH, Knippler ET, Knettel BA, Sikkema KJ, Ciya N, Myer L, Joska JA , 2018. HIV disclosure among pregnant women initiating ART in Cape Town, South Africa: qualitative perspectives during the pregnancy and postpartum periods. AIDS Behav 22: 3945–3956.
-
40.
Bulterys MA et al.2021. Correlates of HIV status nondisclosure by pregnant women living with HIV to their male partners in Uganda: a cross-sectional study. J Acquir Immune Defic Syndr 86: 389–395.
-
41.
Duff P et al.2018. Realizing women living with HIV’s reproductive rights in the era of ART: the negative impact of non-consensual HIV disclosure on pregnancy decisions amongst women living with HIV in a Canadian setting. AIDS Behav 22: 2906–2915.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 2706 | 384 | 36 |
| Full Text Views | 132 | 9 | 2 |
| PDF Downloads | 98 | 11 | 3 |