Happiness Saronga

Fellowship Site: Health for a Prosperous Nation, Tanzia

US Institution: UC Berkeley

Project Title: Cash Transfers to Increase HIV self-testing Uptake among Adolescents in Tanzania: A Randomized Controlled Trial

Adolescents in Tanzania have low HIV testing levels despite having high risk of contracting HIV. Adolescents need innovative HIV services that will increase HIV testing and facilitate early access to treatment. HIV self-testing (HIVST) has been recommended to reach at risk populations who are not utilizing the available testing services. HIVST allows people to test in private and has been shown to be acceptable, safe, and effective in promoting HIV testing in low and middle income countries (LMIC). Nonetheless, knowledge gaps remain on best strategies to increase uptake of HIVST among adolescents, which may eventually promote linkage to confirmatory testing, and care for those testing positive.

This study will test the impact of cash transfers on HIVST uptake among adolescents in Tanzania. The hypothesis is that cash transfers will increase uptake of HIVST among adolescents. Research evidence show cash transfers promote protective behaviors in relation to HIV. Although HIVST is only allowed in adults in Tanzania, the age of consent for HIV testing has been lowered to 15 years, making it possible to test HIVST interventions among adolescents with IRB approval.

The study will be conducted in Shinyanga Region in Tanzania, a region with HIV prevalence of 5.9%, the sixth highest in Tanzania (national prevalence is 5%). Participants will include in-school and out-of-school adolescents. Participants will be randomized to HIVST-cash transfer or HIVST only groups. Cash payment of TSH 10,000 (approximately $4.2) will be made to adolescents in the intervention group upon return of a used HIVST kit. A confirmatory HIV test will be conducted by a health worker for reactive results.

Follow-up data collection will occur over a 6-month period to assess HIV testing as the primary outcome. Secondary outcomes will include HIV positivity rate and linkage to care. Data analysis will compare primary and secondary outcomes between the intervention and control groups. This study will also assess the perspectives of adolescents on the perceived advantages and disadvantages of HIVST, cash transfers and spending pattern of the cash transfers, and incremental cost-effectiveness of the HIVST-cash transfer model.