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Evaluating Lottery-Based Financial Incentives to Prevent HIV and Other Sexually Transmitted Infections (STIs) in Tanzania: A Randomized Evaluation of RESPECT II
Last registered on January 31, 2018

Pre-Trial

Trial Information
General Information
Title
Evaluating Lottery-Based Financial Incentives to Prevent HIV and Other Sexually Transmitted Infections (STIs) in Tanzania: A Randomized Evaluation of RESPECT II
RCT ID
AEARCTR-0002677
Initial registration date
January 31, 2018
Last updated
January 31, 2018 2:50 PM EST
Location(s)

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Primary Investigator
Affiliation
University of California at Berkeley
Other Primary Investigator(s)
PI Affiliation
PI Affiliation
The World Bank
Additional Trial Information
Status
In development
Start date
2018-02-12
End date
2021-06-30
Secondary IDs
Abstract
We are proposing to conduct an intervention study testing the use of financial incentives for HIV prevention among high-risk women in Dar es Salaam. The intervention has been developed from multiple prior pilot phases and builds on results of the RESPECT study that was conducted by the study team in Ifakara, Tanzania. The RESPECT study in Ifakara used financial incentives to motivate safer sex among men and women ages 18-30 in the general population. Participants in the higher value incentive group of that study were found to have a significantly lower prevalence of STIs after one year of study enrollment. This new study will test a similar intervention among female sex workers in Dar es Salaam. We will enroll approximately 2,156 (but request approval to recruit up to 4,000) HIV-negative female sex workers into the study for 2 years. They will be screened for sexually transmitted infections (STIs) at baseline enrollment and offered free treatment if positive. All women tested will also receive pre/post-HIV and STI counselling, as well as extended counselling on safe sex practice and negotiation with partners. They will then be re-screened after 2 years, with counseling at each screening. They will also receive weekly text messages, which will include counseling on safe all for all women, and will be asked to complete a short phone survey after 1 year. Women will be randomized into one of two study arms: the Basic Test group and the Random Test group. Both groups will receive all of the intervention components described above. In addition, in the Random Test group we will randomly draw 10 women each week for random STI testing. If a woman’s random STI tests are negative then the woman will receive an award that day of Tsh100,000 (approximately US$50); if one of the tests is positive then the participant will not receive the reward but she will receive free treatment and further counseling as well as continue to be eligible for future drawings.

This is a population that is a critical node in the HIV epidemic, with HIV positive sex workers potentially causing many more infections among their clients. We hypothesize that providing reward incentives for sex workers to avoid sexually transmitted infections can increase condom use, thus reduce their probability of contracting HIV. In a recent survey of sex workers in Dar es Salaam, 65% reported always using a condom with one-time clients and 32% with steady partners. The report further states that, "among those who did not use condoms, the most common reason was either the client objected or paid more in order not to use them (68.2%)," thus condom price is not a primary reported barrier to use. Based on our own pilot testing we believe that the likelihood of behavior change is promising, and the study is powered to detect a significant reduction in combined new incidence of HSV2 and HIV, two incurable sexually transmitted infections.
External Link(s)
Registration Citation
Citation
Balampama, Marianna, William Dow and Damien Walque. 2018. "Evaluating Lottery-Based Financial Incentives to Prevent HIV and Other Sexually Transmitted Infections (STIs) in Tanzania: A Randomized Evaluation of RESPECT II." AEA RCT Registry. January 31. https://doi.org/10.1257/rct.2677-1.0.
Former Citation
Balampama, Marianna et al. 2018. "Evaluating Lottery-Based Financial Incentives to Prevent HIV and Other Sexually Transmitted Infections (STIs) in Tanzania: A Randomized Evaluation of RESPECT II." AEA RCT Registry. January 31. http://www.socialscienceregistry.org/trials/2677/history/25383.
Experimental Details
Interventions
Intervention(s)
Intervention Start Date
2018-02-12
Intervention End Date
2020-03-06
Primary Outcomes
Primary Outcomes (end points)
The combined incidence of HSV2 and HIV, two incurable sexually transmitted infections. We will also analyze HIV and HSV2 incidence separately, even though we recognize potential power limitations in doing so.
Primary Outcomes (explanation)
Secondary Outcomes
Secondary Outcomes (end points)
Prevalence of syphilis and trichomonas vaginalis, two curable sexually transmitted infections.
Self reported sexual behavior.
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Participants in the random testing arm during the baseline enrollment process will be eligible over the two-year study period to be randomly selected to participate in the STI testing linked to a lottery-based incentive. Each week, 10 women will be randomly selected from the list of random testing arm participants and invited to participate. A participant who tests positive for an STI will receive free STI treatment but will not receive a reward. Participants who are STI negative will receive a reward of 100,000 Tanzanian Shillings (approximately 45USD).
Experimental Design Details
Not available
Randomization Method
Randomization will be performed at registration. Participants will randomly select an envelope which contains their treatment or control allocation.
Randomization Unit
individual
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
n/a
Sample size: planned number of observations
2,156 women
Sample size (or number of clusters) by treatment arms
1078 women treatment, 1078 women control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
University of California at Berkeley
IRB Approval Date
2015-12-07
IRB Approval Number
2015-08-7849