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We evaluated the effectiveness of conditional micro-incentives on linkage to HIV care in the Home-Based Intervention to Test and Start (HITS) trial, a real-world implementation trial in rural South Africa. Of 45 communities in uMkhanyakude, KwaZulu-Natal, 16 were randomized to micro-incentive arms offering food vouchers (R50 [US$3]) conditional on completing home-based HIV counseling and testing (HBHCT) and linkage to care within 6 weeks, and 29 to non-incentive arms. All individuals were eligible for HBHCT, enrolled between February and December 2018, and followed for 1 year. The primary outcome was linkage to care at 1 year among men; secondary outcomes included linkage within the 6-week voucher eligibility period among men and women, and at 1 year among women. Intention-to-treat analyses were performed using Poisson regression adjusted for study arms. Among 13 894 men and 19 884 women eligible for the study (aged \u226515 years), home-based testing uptake was 21% (n = 2867) and 29% (n = 5795), yielding 122 (4.3%) and 375 (6.5%) new diagnoses, respectively. Overall, micro-incentives nearly doubled HIV-positive diagnoses. Among men, micro-incentives did not increase linkage to care within the 6-week voucher eligibility period (risk ratio [RR] = 0.78, 95% CI: 0.51\u20131.21) or at 1 year (RR = 1.08, 95% CI: 0.86\u20131.35). Among women, micro-incentives increased linkage to care within 6 weeks by 51% (RR = 1.51; 95% CI: 1.03\u20132.21), with no residual impact at 1 year (RR = 1.07, 95% CI: 0.91\u20131.26). In a hyperendemic rural African setting, once-off micro-incentives can substantially increase early linkage to HIV care among women during the incentive eligibility period but are inadequate to significantly improve care engagement among men.<\/jats:p>\n                  <jats:p>Trial Registration \u00a0ClinicalTrials.gov NCT03757104.<\/jats:p>","DOI":"10.1093\/heapol\/czag088","type":"journal-article","created":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T11:40:31Z","timestamp":1783856431000},"page":"1527-1542","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the impact of conditional micro-incentives on linkage to HIV care in rural South Africa: results from the Home-Based Intervention to Test and Start (HITS) trial"],"prefix":"10.1093","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5124-1555","authenticated-orcid":false,"given":"Hae-Young","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Population Health, New York University Grossman School of Medicine , 180 Madison Avenue, New York, NY 10016 ,","place":["United States"]},{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Inghels","sequence":"additional","affiliation":[{"name":"Lincoln Institute for Rural and Coastal Health, University of Lincoln , Brayford Pool, Lincoln LN6 7TS ,","place":["United Kingdom"]},{"name":"Centre R\u00e9gional de Recherche et de Formation \u00e0 la Prise en Charge Clinique de Fann, H\u00f4pital Fann , Avenue Cheikh Anta Diop, Dakar ,","place":["Senegal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thulile","family":"Mathenjwa","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Shahmanesh","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"Institute for Global Health, University College London , 30 Guilford Street, London WC1N 1EH ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0583-5272","authenticated-orcid":false,"given":"Janet","family":"Seeley","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"Department of Global Health and Development, London School of Hygiene & Tropical Medicine , Keppel Street, London WC1E 7HT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuala","family":"McGrath","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"School of Primary Care, Population Sciences and Medical Education, University of Southampton , Southampton General Hospital, Tremona Road, SO16 6YD ,","place":["United Kingdom"]},{"name":"Department of Public Health Medicine, University of KwaZulu-Natal , Howard College Campus, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwafemi","family":"Adeagbo","sequence":"additional","affiliation":[{"name":"Department of Sociology, University of Johannesburg , Johannesburg 2006 ,","place":["South Africa"]},{"name":"Department of Community and Behavioral Health, College of Public Health, University of Iowa , 145 N. Riverside Drive, Iowa City, IA 52242 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dickman","family":"Gareta","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H Manisha","family":"Yapa","sequence":"additional","affiliation":[{"name":"Kirby Institute, University of New South Wales \u00a0 Sydney, Level 6, Wallace Wurth Building, High Street, NSW 2052 ,","place":["Australia"]},{"name":"Sydney Infectious Diseases Institute, University of Sydney , Level 5, Block K, Westmead Central Acute Services Building (CASB), 176 Hawkesbury Road, Westmead, NSW 2145 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thembelihle","family":"Zuma","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"Department of Public Health Medicine, University of KwaZulu-Natal , Howard College Campus, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"Division of Infection and Immunity, University College London , Gower Street, London WC1E 6BT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Dobra","sequence":"additional","affiliation":[{"name":"University of Washington , Box 354322, Seattle, Washington 98195 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Till W","family":"B\u00e4rnighausen","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3 , Heidelberg 69120 ,","place":["Germany"]},{"name":"Department of Global Health and Population, Harvard T.H. Chan School of Public Health , Harvard University, 665 Huntington Avenue, Boston, MA 02115 ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9797-0000","authenticated-orcid":false,"given":"Frank","family":"Tanser","sequence":"additional","affiliation":[{"name":"Africa Health Research Institute , 719 Umbilo Road, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"Department of Public Health Medicine, University of KwaZulu-Natal , Howard College Campus, Durban 4001, KwaZulu-Natal ,","place":["South Africa"]},{"name":"South Africa Centre for Epidemiological Modelling and Analysis (SACEMA), Centre for Epidemic Response and Innovation (CERI), School for Data Science and Computational Thinking, Stellenbosch University , 19 Jonkershoek Road, Stellenbosch 7600 ,","place":["South Africa"]},{"name":"Center for the AIDS Programme of Research in South Africa (CAPRISA) , University of KwaZulu-Natal, 719 Umbilo 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