Soft and hard commitment devices to increase HIV testing

Last registered on October 08, 2021

Pre-Trial

Trial Information

General Information

Title
Soft and hard commitment devices to increase HIV testing
RCT ID
AEARCTR-0004295
Initial registration date
June 21, 2019
Last updated
October 08, 2021, 9:47 PM EDT

Locations

Region

Primary Investigator

Affiliation
University of Oxford

Other Primary Investigator(s)

PI Affiliation
University of Minnesota
PI Affiliation
University of Toronto
PI Affiliation
University of Minnesota

Additional Trial Information

Status
Completed
Start date
2019-06-21
End date
2020-12-31
Secondary IDs
Prior work
This trial does not extend or rely on any prior RCTs.
Abstract
Our goal is to study innovative ways to overcome the challenge of getting HIV-positive people into the treatment pipeline. Despite the availability of free, life-saving treatment, nearly one million people died of AIDS in 2017. This is largely driven by low HIV testing rates: a quarter of those living with HIV do not know their status (WHO 2017). In Africa this problem is worse for men, in part because pregnant women are routinely tested and treated for HIV. We will investigate whether a soft commitment device (a scheduled appointment) and a hard commitment device (a small money transfer conditional on HIV testing) can increase HIV testing among men in Zomba Town, Malawi.
External Link(s)

Registration Citation

Citation
Derksen, Laura et al. 2021. "Soft and hard commitment devices to increase HIV testing." AEA RCT Registry. October 08. https://doi.org/10.1257/rct.4295-2.3000000000000003
Former Citation
Derksen, Laura et al. 2021. "Soft and hard commitment devices to increase HIV testing." AEA RCT Registry. October 08. https://www.socialscienceregistry.org/trials/4295/history/101373
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
We will investigate whether a soft commitment device (a scheduled appointment) and a hard commitment device (small money transfer conditional on HIV testing) can increase HIV testing among men in Zomba Town, Malawi.

We believe that procrastination (a tendency to delay) is a barrier to HIV testing for many people. We will assess the impact of two interventions that aim at reducing procrastination and thereby overcome the problem of continuously putting off HIV testing.

(1) A soft commitment device: selected participants will be offered scheduled appointments to test for HIV. Appointments are devices for mental and social commitment.

(2) A hard commitment device: selected participants will be invited to invest in a mechanism that conditions a small transfer of money on testing for HIV.
Intervention Start Date
2019-06-21
Intervention End Date
2019-09-30

Primary Outcomes

Primary Outcomes (end points)
Our primary outcome variable is a testing dummy collected at clinics when participants redeem their voucher. The testing dummy will be equal to 1 for participants who redeemed their voucher and then agreed to get tested, and equal to 0 otherwise.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
We will consider two secondary outcomes collected at clinics:

(1) A "tested HIV+ dummy": a dummy variable equal to 1 for participants who redeemed their voucher and tested HIV+, and equal to 0 otherwise.

(2) An "ART dummy": a dummy variable equal to 1 for participants who redeemed their voucher and agreed to initiate ARV treatment after testing HIV+, and equal to 0 otherwise.

These outcomes are considered as secondary not because they are uninteresting (quite the contrary) but rather because power will most likely be insufficient to detect any effect.
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
We use a factorial design.
Experimental Design Details
Participants are split into four treatment arms. They are randomized at the individual level without stratification.

All participants receive a 1000K gift of airtime at the end of the survey, and a 500K airtime voucher for redemption at any HIV testing site in Zomba Town. They do not have to agree to an HIV test to redeem this voucher.

Prior to applying the results of the randomization, we will elicit preference for a hard commitment device from each participant.

0: 25% are assigned to the control group.

1: 25% of participants will then be offered the hard commitment device. The original preference we elicited from all participants will be honoured. If their preference was to refuse the commitment device, they receive an immediate payment of 1000K. If their preference was to accept, they forego the immediate payment of 1000K, but can receive a 1000K transfer if they show up at one of the HIV testing sites. They do not have to agree to an HIV test.

2: 25% of participants will be offered a scheduled appointment to test for HIV. They are allowed to refuse the appointment.

3: 25% of participants will be offered both the hard commitment device and the appointment.

The effect of the soft commitment device (being offered an appointment) can measured by comparing those randomly selected to get an appointment (groups 2 and 3) to those who were not (groups 0 and 1).

The intent-to-treat effect of offering the hard commitment device can measured by comparing those who were assigned to groups 1 and 3 to those assigned to groups 0 and 2. We can also measure the effect on compliers using the same comparison, but restricting our sample to those who preferred the hard commitment device.
Randomization Method
The randomization process will be predefined in a .csv downloaded on survey tablets, and hence reproducible. Randomization will be at the individual level without stratification. Each study participant will be automatically allocated to a treatment arm based on their Study ID which is composed of their enumerator ID, day of the study, and number of the survey. For example, the first enumerator’s first respondent on the first day of the study will have Study ID 010101.
Randomization Unit
Individual
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
No cluster
Sample size: planned number of observations
1200 individuals
Sample size (or number of clusters) by treatment arms
For the soft commitment device intervention (appointments), we will have 600 participants in the treatment group and 600 participants in the control group.

For the hard commitment device intervention (conditional money transfer) , we will have 600 participants in the treatment group and 600 participants in the control group for the intent-to-treat analysis. When calculating the average treatment effect on the treated, the sample size will depend on the take-up rate of the hard commitment device: denoting this take-up rate r, 600*r participants will be in the treatment group and 600*r participants will be in the control group for this analysis.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Supporting Documents and Materials

Documents

Document Name
analysis_baselinedata
Document Type
other
Document Description
File
analysis_baselinedata

MD5: 9a48766cb20b80219290b5f26c40d670

SHA1: afec7d52008eec5d9a884409540d8c8eadf1a414

Uploaded At: September 21, 2019

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IRB

Institutional Review Boards (IRBs)

IRB Name
Human research protection program
IRB Approval Date
2019-04-09
IRB Approval Number
STUDY00005587
IRB Name
National Health Sciences Research Committee
IRB Approval Date
2019-04-05
IRB Approval Number
2268
Analysis Plan

Analysis Plan Documents

PAP

MD5: 3274a354b1f7383440b94b80601922fa

SHA1: 236255c663093d7195cb5353ef69d90b43d84fca

Uploaded At: September 21, 2019

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials