Economic strengthening for HIV testing and linkage to care: a review of the evidence

ABSTRACT

Delayed HIV diagnosis and enrollment in HIV care can lead to negative health outcomes for individuals and pose major barriers to achieving the UNAIDS 90-90-90 treatment targets. Household economic strengthening (HES) initiatives are increasingly used to alleviate the direct and indirect costs of HIV testing and linkage to care for those who are diagnosed. The evidence linking HES with a range of HIV outcomes is growing, and this evidence review aimed to comprehensively synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search. Given the volume of evidence, the results are presented and discussed in three papers. This is the second paper in the series and focuses on the 20 studies on HIV testing, diagnosis, and enrollment in care. The results indicate that financial incentives are consistently and independently linked with higher testing uptake and yield among adults. Limited evidence indicates they may also be beneficial for enrollment in care. Evidence for other HES interventions is too sparse to identify clear trends.

KEYWORDS:

• Evidence review
• economic strengthening
• HIV testing
• antiretroviral therapy

Acknowledgments

We would like to acknowledge the excellent work of Cheryl Tam, formerly of FHI 360, in screening and assessing the quality of articles included in this review. We are grateful to several FHI 360 colleagues, including Whitney Moret for her contributions to this manuscript, Allison Burns and Tamara Fasnacht for their support in the literature search, and Jenae Tharaldson for her assistance preparing the manuscript. Finally, we would like to thank the researchers, donors and practitioners who participated in the half-day consultative meeting held on 13 July 2016 for their thoughtful input and expertise on this topic.

Disclosure statement

The author has no conflicts of interest to declare.

ORCID

Mandy Swann http://orcid.org/0000-0003-0348-8024

Notes

1 Green (positive) = positive findings on one or more primary outcome of interest and no negative findings; blue (null) = no effect/association was observed on primary outcome(s) or study was under-powered; yellow (mixed) = a mix of positive and negative results on primary outcomes of interest; and red (negative) = negative findings on one or more primary outcomes of interest and no positive findings.

Additional information

Funding

This study was produced under United States Agency for International Development (USAID) Cooperative Agreement No. AID-OAA-LA-13-00001 and was made possible by the generous support of the American people through USAID and the United States President’s Emergency Plan for AIDS Relief. The contents are the responsibility of FHI 360 and do not necessarily reflect the views of USAID or the United States Government.