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Intern. AIDS Soc."],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The uptake of HIV testing and linkage to care remains low among men, contributing to high HIV incidence in women in South Africa. We conducted the \u201cHome\u2010Based Intervention to Test and Start\u201d (HITS) in a 2x2 factorial cluster randomized controlled trial in one of the World\u2019s largest ongoing HIV cohorts in rural South Africa aimed at enhancing both intrinsic and extrinsic motivations for HIV testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between February and December 2018, in the uMkhanyakude district of KwaZulu\u2010Natal, we randomly assigned 45 communities (clusters) (n\u00a0=\u00a013,838 residents) to one of the four arms: (i) financial incentives for home\u2010based HIV testing and linkage to care (R50 [$3] food voucher each); (ii) male\u2010targeted HIV\u2010specific decision support application, called EPIC\u2010HIV; (iii) both financial incentives and male\u2010targeted HIV\u2010specific decision support application and (iv) standard of care (SoC). EPIC\u2010HIV was developed to encourage and serve as an intrinsic motivator for HIV testing and linkage to care, and individually offered to men via a tablet device. Financial incentives were offered to both men and women. Here we report the effect of the interventions on uptake of home\u2010based HIV testing among men. Intention\u2010to\u2010treat (ITT) analysis was performed using modified Poisson regression with adjustment for clustering of standard errors at the cluster levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among all 13,838 men\u00a0\u2265\u00a015\u00a0years living in the 45 communities, the overall population coverage during a single round of home\u2010based HIV testing was 20.7%. The uptake of HIV testing was 27.5% (683\/2481) in the financial incentives arm, 17.1% (433\/2534) in the EPIC\u2010HIV arm, 26.8% (568\/2120) in the arm receiving both interventions and 17.8% in the SoC arm. The probability of HIV testing increased substantially by 55% in the financial incentives arm (risk ratio (RR)=1.55, 95% CI: 1.31 to 1.82, p\u00a0&lt;\u00a00.001) and 51% in the arm receiving both interventions (RR\u00a0=\u00a01.51, 95% CI: 1.21 to 1.87 p\u00a0&lt;\u00a00.001), compared to men in the SoC arm. The probability of HIV testing did not significantly differ in the EPIC\u2010HIV arm (RR\u00a0=\u00a00.96, 95% CI: 0.76 to 1.20, p\u00a0=\u00a00.70).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The provision of a small financial incentive acted as a powerful extrinsic motivator substantially increasing the uptake of home\u2010based HIV testing among men in rural South Africa. In contrast, the counselling and testing application which was designed to encourage and serve as an intrinsic motivator to test for HIV did not increase the uptake of home\u2010based testing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25665","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T22:29:48Z","timestamp":1613600988000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Home\u2010Based Intervention to Test and Start (HITS): a community\u2010randomized controlled trial to increase HIV testing uptake among men in rural South Africa"],"prefix":"10.1002","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9797-0000","authenticated-orcid":false,"given":"Frank C","family":"Tanser","sequence":"first","affiliation":[{"name":"Africa Health Research Institute Durban South Africa"},{"name":"Lincoln International Institute for Rural Health University 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