Planning and commitment prompts to encourage reporting of HIV self-test results: A cluster randomized pragmatic trial in Tshwane District, South Africa

Reporting of HIV self-test results to encourage linkage to HIV care for those who receive a positive test result is a common challenge faced by HIV self-testing programs. The impact of self-testing programs is diminished if individuals who obtain a self-test do not use the test or seek confirmatory testing and initiate HIV treatment following a positive result. We conducted a cluster randomized trial of two interventions designed to increase reporting of HIV self-test results: a “plan and commit” intervention that leveraged insights from behavioral economics, and an enhanced usual care version of the standard HIV self-test community distribution protocol that promoted the importance of reporting results. The trial was conducted at community distribution sites for HIV self-tests in Tshwane Metropolitan Municipality, Gauteng Province, South Africa. The primary outcome was reporting of self-test results via a WhatsApp messaging system. We recruited 1,478 participants at 13 distribution sites over 24 days. In the plan and commit condition, 63/731 participants (8.7%) reported their test results via WhatsApp, compared to 59/747 participants (7.9%) in the enhanced usual care condition (n.s., p= 0.61). During the study period, 101/3,199 individuals (3.1%) who received a self-test under the standard protocol reported test results via WhatsApp, a significant difference across the three arms (p < .00001). Our results suggest that boosting the reporting of self-test results can be done solely through increasing the salience of the importance of reporting and a clear explanation of the procedure for reporting results.

向医疗机构报告 HIV 自检结果，以鼓励阳性检测结果者寻求 HIV 治疗，是 HIV 自检项目普遍面临的挑战。若接受自检的个人未使用检测工具或寻求确认性检测，并在阳性结果后启动 HIV 治疗，则自检项目的成效将大打折扣。本研究旨在通过集群随机试验评估两种旨在提高 HIV 自检结果报告率的干预措施：一种利用行为经济学洞察力的“计划与承诺”干预措施，以及一种强化常规护理的 HIV 自检社区分发方案，强调报告结果的重要性。试验于南非豪登省茨瓦内大都会地区的 HIV 自检社区分发点进行。主要结局指标是通过 WhatsApp 消息系统报告自检结果。我们在 24 天内招募了 13 个分发点的 1478 名参与者。在计划与承诺组中，731 名参与者中有 63 人（8.7%）通过 WhatsApp 报告了他们的检测结果，而在强化常规护理组中，747 名参与者中有 59 人（7.9%）通过 WhatsApp 报告了检测结果（无显著差异，p=0.61）。在研究期间，按照标准方案接受自检的 3199 人中有 101 人（3.1%）通过 WhatsApp 报告了检测结果，三组之间存在显著差异（p < .00001）。我们的研究结果表明，通过提高报告结果的重要性及其报告程序的明确解释，可以有效地提升自检结果的报告率。