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Effectiveness of Behavioural Economics Informed Interventions for the Prevention, Screening, and Antiretroviral Treatment of HIV Infection: A Systematic Review of Randomized Controlled Trials

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Abstract

Failure to meet international targets set for the human immunodeficiency virus HIV pandemic suggests that more effective public health strategies are needed. New strategies informed by behavioural economics are now increasingly being tested, with promising results. However, the evidence base is diverse and challenging for policymakers to interpret. This paper aims to synthesise existing evidence by reporting results from a systematic review of behavioural economics-based interventions for addressing HIV prevention, testing and treatment. The reported study was a systematic review of randomized controlled trials. The search was conducted in four electronic medical literature databases, six trial registries, four grey literature sources and was not restricted to any country or region. Bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews; quality of evidence was assessed using GRADE methodology. Fifteen full text articles were included in the final analysis. The synthesis of these studies revealed that strategies involving opt-out defaults, active-choice defaults, and lottery incentives can potentially increase uptake of HIV testing. Lottery incentives also showed signs of effectiveness in improving HIV prevention, ART adherence and initiation. Despite the promising findings, the overall evidence was judged to be of moderate to very low quality. Behavioural economics-based interventions are promising behavioural change strategies, although more well-designed studies are needed to strengthen the evidence base.

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Data Availability

The detailed search strategies used for this systematic review are available in the form of supplementary materials.

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Acknowledgements

The authors are grateful to David Burns, Information Officer, Health Economics Research Unit, University of Aberdeen, for assistance with the electronic bibliographic search strategies and for proof-reading the article.

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No funding was received to assist with the preparation of this manuscript.

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Authors and Affiliations

  1. Parklands Kidney Center, Nairobi, Kenya

    Ahmed Abdirizak Ahmed

  2. Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland

    Paul McNamee

  3. Aga Khan University Hospital, Nairobi, Kenya

    Ahmed Abdirizak Ahmed

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  1. Ahmed Abdirizak Ahmed
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AAA and checked for accuracy and completeness by PMN. The first draft of the manuscript was written by AAA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ahmed Abdirizak Ahmed.

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Ahmed, A.A., McNamee, P. Effectiveness of Behavioural Economics Informed Interventions for the Prevention, Screening, and Antiretroviral Treatment of HIV Infection: A Systematic Review of Randomized Controlled Trials. AIDS Behav 27, 3521–3534 (2023). https://doi.org/10.1007/s10461-022-03969-y

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