Incentives to Improve HIV Testing in Oakland

Sandy McCoy, University of California, Berkeley
Social and Behavioral Sciences
Targeted Theme: HIV-Related Disparities in Highly Impacted, Under-researched Populations
Innovative, Developmental, Exploratory Award (IDEA)

Unrecognized HIV infection and late diagnosis is major public health issue. Approximately one in five people living with HIV/AIDS in the U.S. is unaware of their status, and nearly 40% of people diagnosed with HIV from 1996-2005 received an AIDS diagnosis within one year of their first positive test (“late diagnosis”). In addition to limiting the benefits of early treatment and access to other clinical and social services, persons with unrecognized infection may unknowingly transmit HIV to others. In this proposal we focus on the HIV epidemic in Oakland, California, which is shaped by staggering racial disparities: African Americans account for 60% of all AIDS cases in Oakland yet are only 31% of the population. Further, 45% of African American HIV diagnoses were late compared to only 28% of White diagnoses. It is unknown why so many more African Americans are diagnosed late, nor how to improve the numbers of African Americans who are aware of their status so they can receive the benefits of timely clinical care.

To address this issue, we have designed an innovative pilot study with the Get Screened Oakland Program to improve HIV testing uptake by African American adults who have never tested before and who may not perceive themselves to be at risk for HIV infection. Drawing on theories from health behavior and behavioral economics, we will evaluate the effect of financial incentives built into a novel peer recruitment strategy to remove stigma and to promote initial and repeat testing among Oakland’s “invisible” population of adults who are unaware of their HIV status. We will build on recent research using social networks to compare the effect of peer recruitment alone and peer recruitment with financial incentives on HIV testing uptake.

In the first phase of the study, focus group discussions with African American adult clients of HIV voluntary counseling and testing (VCT) sites will assist in determining the appropriate amounts and types of incentives to motivate HIV testing. In the second phase of the study, approximately 300 35-55 year old African American adults who have never received an HIV test will be recruited using a respondent driven sampling (RDS) approach. RDS is a rigorous method to recruit “hidden” populations using successive waves of peer recruitment. To evaluate the effect of incentives, participants will be randomized to receive referral coupons to distribute to new testers that either 1) list a VCT site only, or 2) list a VCT site plus an offer of an incentive for testing. HIV-negative participants at high risk will be encouraged to remain in a repeat testing program and re-test after six months and one year. Individuals who test HIV positive at any point will be promptly referred for care. After one year of follow-up, we will evaluate whether the incentives improved testing uptake and whether the incentives improved retention in a long term testing program.

This study will provide preliminary evidence for the development of programs for African American adults using peer recruitment and/or financial incentives, an approach which could have an important impact on the HIV epidemic if it can identify a network of high-risk people who are unaware of their status and motivate them to seek testing and care.