Direct and Spillover Impacts of a Community-Level HIV/AIDS Program: Evidence from a Randomized Controlled Trial in Mozambique

Last registered on August 04, 2022

Pre-Trial

Trial Information

General Information

Title
Direct and Spillover Impacts of a Community-Level HIV/AIDS Program: Evidence from a Randomized Controlled Trial in Mozambique
RCT ID
AEARCTR-0003990
Initial registration date
March 08, 2019

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
March 08, 2019, 4:02 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
August 04, 2022, 2:29 PM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Region

Primary Investigator

Affiliation
University of Michigan

Other Primary Investigator(s)

PI Affiliation
University of Michigan
PI Affiliation
University of Michigan
PI Affiliation
Beira Operational Research Center

Additional Trial Information

Status
Completed
Start date
2017-01-01
End date
2020-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
We study a prominent effort to help families cope with HIV/AIDS: a U.S. government-funded program in Mozambique implementing an interrelated set of health and education interventions. We report the results of a randomized evaluation of this program. We hypothesize that the program raises HIV testing rates by reducing imperfect information (related to HIV) and by reducing HIV-related stigma concerns. Primary outcome variables are survey-reported and directly-observed rates of HIV testing. We also examine a range of secondary outcomes related to information and stigma mechanisms, and secondary outcome variables such as school attendance and overall household well-being. Causal identification exploits multilevel random assignment (of communities to program receipt, and of treatment-community households to strong encouragement for program participation), allowing separate identification of impacts on households of being in a program community (with take-up at the community-average rate), versus having been strongly encouraged to participate the program (with very high take-up). We also examine spillovers (based on geographic proximity or social network connections) from strongly encouraged to other households. Additional treatments randomly assigned by our research team allow insight into complementarities with interventions providing targeted information and financial incentives for HIV testing.
External Link(s)

Registration Citation

Citation
Mahumane, Arlete et al. 2022. "Direct and Spillover Impacts of a Community-Level HIV/AIDS Program: Evidence from a Randomized Controlled Trial in Mozambique." AEA RCT Registry. August 04. https://doi.org/10.1257/rct.3990
Former Citation
Mahumane, Arlete et al. 2022. "Direct and Spillover Impacts of a Community-Level HIV/AIDS Program: Evidence from a Randomized Controlled Trial in Mozambique." AEA RCT Registry. August 04. https://www.socialscienceregistry.org/trials/3990/history/152254
Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2017-01-01
Intervention End Date
2020-12-31

Primary Outcomes

Primary Outcomes (end points)
We consider the following outcome variable to be primary outcome of interest: HIV testing at the household level (binary outcome)
Primary Outcomes (explanation)
The outcome variable of primary interest is HIV testing at the household level. This will be a binary outcome indicating that the household either self-reports having had or is directly observed by our survey staff having an HIV test upon our recommendation. This outcome captures the combination of having already had an HIV test, as well as openness to recommendations for future testing, both of which may be influenced by exposure to the FCC program.
To be specific, the component variables of this outcome variable are:

- HIV testing (self-reported): an indicator that anyone in the household has been tested for HIV in the last 12 months. This is a household-level variable equal to 1 if at least one household member is reported to have had an HIV test in the last 12 months, and 0 otherwise.
- HIV testing (directly observed): an indicator that at least one of a household’s HIV testing coupons has been redeemed. This is a household-level variable equal to 1 if at least one of a household’s incentive coupons is presented at the local health clinic for the HIV testing incentive payment before the 14-day deadline, and 0 otherwise.

Our composite HIV testing outcome is therefore equal to 1 if HIV testing (self-reported) is equal to 1 or HIV testing (directly observed) is equal to 1, and 0 otherwise.

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study uses a three-stage randomized controlled trial (RCT) methodology.
Stage 1: communities were randomly assigned to treatment or control status (inclusion in or exclusion from the FCC program).
Stage 2: a subset of households within FCC treatment communities were randomly assigned to a strong encouragement to participate in FCC programs (“directly enrolled” households). These directly enrolled households receive a home visit by an FCC program community worker and are assessed for inclusion in various FCC subcomponent programs.
Stage 3: as part of the endline survey, households in all communities (treatment and control) are randomly assigned to treatments to provide information about HIV, provide information about HIV treatment (antiretroviral therapy, or ART), provide both HIV and ART information, reduce concerns about HIV-related stigma, and receive higher compensation for getting an HIV test.
Experimental Design Details
Randomization Method
Randomization done in office by a computer
Randomization Unit
Stage 1: communities (38 treatment, 38 control)
Stage 2: households within FCC treatment communities
Stage 3: households in all communities
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
For Randomization Stage 1, 76 communities as clusters (38 treatment, 38 control).
Randomization Stages 2 and 3 are at the household level, not clustered.
Sample size: planned number of observations
76 communities as clusters (38 treatment, 38 control). 4,560 households across all communities.
Sample size (or number of clusters) by treatment arms
Randomization Stage 1: 76 communities as clusters (38 treatment, 38 control). 60 households in each community are included in survey sample.
Randomization Stage 2: 35 households in each treatment community randomly assigned to direct enrollment in FCC program; 25 in each treatment community are controls (not assigned to direct enrollment).
Randomization Stage 3: equal share of households assigned to each of six treatment conditions (HIV information, ART information, both HIV and ART information, anti-stigma, high incentive for HIV testing, and control).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board
IRB Approval Date
2016-03-23
IRB Approval Number
HUM00113011
Analysis Plan

Analysis Plan Documents

Updated PAP - JDE Registered Report

MD5: e5e16d9f9ef9fa5670b4ff1c03ce1a66

SHA1: 06f80e39b1371a14f8e521dffad7dd85ab9e055c

Uploaded At: July 24, 2019

Pre-Analysis Plan

MD5: 2b448879498b05d01b45bc6bb8adfc0e

SHA1: b1f0236948df1cd8063d1ca63cebb976e23c652b

Uploaded At: March 08, 2019

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Yes
Data Collection Completion Date
Final Sample Size: Number of Clusters (Unit of Randomization)
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
Final Sample Size (or Number of Clusters) by Treatment Arms
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials

Description
Populated PAP
Citation
Mahumane, Arlete et al. 2022. "Direct and Spillover Impacts of a Community-Level HIV/AIDS Program: Evidence from a Randomized Controlled Trial in Mozambique." AEA RCT Registry. August 04. 2022. "Registration Entry Title: Populated PAP." AEA RCT Registry. August 04 https://doi.org/10.1257/rct.3990
File
yangetalFCC2021_populatedPAP.pdf

MD5: c4e5c1f56dd1a045458c846d13e6572b

SHA1: 74582fe5ad7d1926218f014471f380c9c6abf2ae

Uploaded At: August 04, 2022