Love in the Time of HIV: Testing as a Signal of Risk

Last registered on April 17, 2020

Pre-Trial

Trial Information

General Information

Title
Love in the Time of HIV: Testing as a Signal of Risk
RCT ID
AEARCTR-0005733
Initial registration date
April 17, 2020
Last updated
April 17, 2020, 12:55 PM EDT

Locations

Region

Primary Investigator

Affiliation
University of Toronto

Other Primary Investigator(s)

Additional Trial Information

Status
Completed
Start date
2013-10-01
End date
2014-10-01
Secondary IDs
Abstract
Ending the AIDS epidemic is within reach due to lifesaving antiretroviral treatment which also prevents transmission. However, demand for HIV testing is low, and stigma is a potential barrier. We model HIV testing as a signal of risk, which causes discrimination from sexual partners who fear contracting HIV. We provide new information, randomized at the community level: antiretroviral treatment prevents HIV transmission, so a sexual partner who is diagnosed and treated is relatively safe. This reduces discrimination and increases HIV testing. These results suggest that HIV discrimination is partly explained by misinformation and can be mitigated.
External Link(s)

Registration Citation

Citation
Derksen, Laura. 2020. "Love in the Time of HIV: Testing as a Signal of Risk." AEA RCT Registry. April 17. https://doi.org/10.1257/rct.5733-1.0
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
We conducted community health education meetings in both control and intervention villages. This allows us to isolate the impact of one piece of information: ART drugs provide a public benefit by preventing HIV transmission.

In the control arm we provided information only on the private benefits of ART. Community educators started the meeting by asking for a show of hands: 75 percent of attendees believed that ART allowed HIV positive individuals to lead a long and healthy life. Educators then explained that ART increases life expectancy, reduces the symptoms of AIDS, and is free at local clinics. Educators explained the mechanism by which ART reduces AIDS symptoms using an infographic that depicts a reduction in viral load.

In the intervention arm we provided information on both the private and public benefits of ART. Community educators started by providing the same basic information as in the control arm. Next, they asked whether participants believed that ART had an effect on HIV transmission. Only 5 percent of meeting attendees raised their hands. Note that we did not ask this question in the control arm, to avoid priming respondents by suggesting such an effect might exist. Educators explained that correct adherence to ART reduces the probability of HIV transmission by 96 percent. This is slightly conservative: the 96 percent reduction in transmission is based on a study which took place primarily in sub-Saharan Africa and in which adherence was not perfectly monitored (Cohen et. al., 2011). More recent studies show that complete viral load suppression likely eliminates the risk of HIV transmission. They used an infographic to explain that ART reduces a person's viral load, which leads to a reduction in transmission risk. Educators emphasized the importance of correct adherence. Indeed, ART users do not always practice good adherence, and we were careful not to claim that ART users in general were safe sexual partners.

The meetings were balanced in length (approximately 45 minutes) and community participation (one opportunity to raise hands, and time for clarifying questions at the end).

We conducted the intervention over three weeks at the end of 2013. In order to avoid information spillovers, educators conducted the control village meetings before training for and implementing the intervention. The topic of the meeting was not announced ahead of time. Village chiefs advertised the meetings and took attendance, and in exchange received small personal gifts of soap and salt. We did not provide incentives for attendance. The educators knew they would receive incentives based on knowledge retention in both control and intervention villages.
Intervention Start Date
2013-11-15
Intervention End Date
2013-12-09

Primary Outcomes

Primary Outcomes (end points)
Beliefs about the effect of ART on HIV transmission, discrimination towards sexual partners taking ART, HIV testing
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Our sample includes 122 villages from two Traditional Authorities in Zomba District. We selected villages based on unique name in the district, to be able to link them to administrative clinic data.

We randomly assigned villages to either a control or intervention arm. We stratified on above-median population and district-assigned clinic. The sample appears balanced on observable village characteristics.
Experimental Design Details
Randomization Method
Randomization was done in Stata.
Randomization Unit
Village.
Was the treatment clustered?
No

Experiment Characteristics

Sample size: planned number of clusters
122
Sample size: planned number of observations
122
Sample size (or number of clusters) by treatment arms
62 villages control, 60 villages treatment
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
London School of Economics Research and Ethics Committee
IRB Approval Date
2013-06-26
IRB Approval Number
N/A
IRB Name
Malawi College of Medicine Research and Ethics Committee
IRB Approval Date
2013-09-23
IRB Approval Number
P.08/13/1436

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
Yes
Intervention Completion Date
December 09, 2013, 12:00 +00:00
Data Collection Complete
Yes
Data Collection Completion Date
October 01, 2014, 12:00 +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
122 villages
Was attrition correlated with treatment status?
No
Final Sample Size: Total Number of Observations
122 villages
Final Sample Size (or Number of Clusters) by Treatment Arms
62 control, 60 treatment
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
No
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials