{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:36:37Z","timestamp":1787960197787,"version":"build-2784847793"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003630","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000}}],"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH105254"],"award-info":[{"award-number":["R01MH105254"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R01MH105254"],"award-info":[{"award-number":["R01MH105254"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Frequent retesting for HIV among persons at increased risk of HIV infection is critical to early HIV diagnosis of persons and delivery of combination HIV prevention services. There are few evidence-based interventions for promoting frequent retesting for HIV. We sought to determine the effectiveness of financial incentives and deposit contracts in promoting quarterly HIV retesting among adults at increased risk of HIV.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>In peri-urban Ugandan communities from October to December 2018, we randomized HIV\u2013negative adults with self-reported risk to 1 of 3 strategies to promote HIV retesting: (1) no incentive; (2) cash incentives (US$7) for retesting at 3 and 6 months (total US$14); or (3) deposit contracts: participants could voluntarily deposit US$6 at baseline and at 3 months that would be returned with interest (total US$7) upon retesting at 3 and 6 months (total US$14) or lost if participants failed to retest. The primary outcome was retesting for HIV at both 3 and 6 months. Of 1,482 persons screened for study eligibility following community-based recruitment, 524 participants were randomized to either no incentive (<jats:italic>N =<\/jats:italic> 180), incentives (<jats:italic>N<\/jats:italic> = 172), or deposit contracts (<jats:italic>N<\/jats:italic> = 172): median age was 25 years (IQR: 22 to 30), 44% were women, and median weekly income was US$13.60 (IQR: US$8.16 to US$21.76). Among participants randomized to deposit contracts, 24\/172 (14%) made a baseline deposit, and 2\/172 (1%) made a 3-month deposit. In intent-to-treat analyses, HIV retesting at both 3 and 6 months was significantly higher in the incentive arm (89\/172 [52%]) than either the control arm (33\/180 [18%], odds ratio (OR) 4.8, 95% CI: 3.0 to 7.7, <jats:italic>p<\/jats:italic> &lt; 0.001) or the deposit contract arm (28\/172 [16%], OR 5.5, 95% CI: 3.3 to 9.1, <jats:italic>p<\/jats:italic> &lt; 0.001). Among those in the deposit contract arm who made a baseline deposit, 20\/24 (83%) retested at 3 months; 11\/24 (46%) retested at both 3 and 6 months. Among 282 participants who retested for HIV during the trial, three (1%; 95%CI: 0.2 to 3%) seroconverted: one in the incentive group and two in the control group. Study limitations include measurement of retesting at the clinic where baseline enrollment occurred, only offering clinic-based (rather than community-based) HIV retesting and lack of measurement of retesting after completion of the trial to evaluate sustained retesting behavior.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Offering financial incentives to high-risk adults in Uganda resulted in significantly higher HIV retesting. Deposit contracts had low uptake and overall did not increase retesting. As part of efforts to increase early diagnosis of HIV among high-risk populations, strategic use of incentives to promote retesting should receive greater consideration by HIV programs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>clinicaltrials.gov: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02890459\" xlink:type=\"simple\">NCT02890459<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003630","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T20:16:57Z","timestamp":1620159417000},"page":"e1003630","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":22,"title":["Financial incentives and deposit contracts to promote HIV retesting in Uganda: A randomized trial"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5860-8081","authenticated-orcid":true,"given":"Gabriel","family":"Chamie","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalsone","family":"Kwarisiima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8420-462X","authenticated-orcid":true,"given":"Alex","family":"Ndyabakira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Marson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5615-1164","authenticated-orcid":true,"given":"Carol S.","family":"Camlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane V.","family":"Havlir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses R.","family":"Kamya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3308-7603","authenticated-orcid":true,"given":"Harsha","family":"Thirumurthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,5,4]]},"reference":[{"issue":"9","key":"pmed.1003630.ref001","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1056\/NEJMoa1506816","article-title":"Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection","volume":"373","author":"JD Lundgren","year":"2015","journal-title":"N Engl J Med"},{"issue":"6","key":"pmed.1003630.ref002","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1056\/NEJMoa1105243","article-title":"Prevention of HIV-1 infection with early antiretroviral therapy","volume":"365","author":"MS Cohen","year":"2011","journal-title":"N Engl J Med"},{"issue":"Suppl 2","key":"pmed.1003630.ref003","doi-asserted-by":"crossref","first-page":"S113","DOI":"10.1097\/QAI.0000000000002169","article-title":"PrEP 1.0 and Beyond: Optimizing a Biobehavioral Intervention","volume":"82","author":"KH Mayer","year":"2019","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pmed.1003630.ref004","author":"World Health Organization","year":"2019","journal-title":"Policy Brief: Consolidated Guidelines on HIV Testing Services for a Changing Epidemic"},{"key":"pmed.1003630.ref005","author":"Uganda Ministry of Health","year":"2018","journal-title":"Consolidated Guidelines for the Prevention and Treatment of HIV and AIDS in Uganda. Second Edition\u2014September 2018"},{"issue":"4","key":"pmed.1003630.ref006","doi-asserted-by":"crossref","first-page":"e62212","DOI":"10.1371\/journal.pone.0062212","article-title":"Low rates of repeat HIV testing despite increased availability of antiretroviral therapy in rural Tanzania: findings from 2003\u20132010","volume":"8","author":"C Cawley","year":"2013","journal-title":"PLoS ONE"},{"issue":"4","key":"pmed.1003630.ref007","doi-asserted-by":"crossref","first-page":"e62362","DOI":"10.1371\/journal.pone.0062362","article-title":"Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa","volume":"8","author":"S Regan","year":"2013","journal-title":"PLoS ONE"},{"issue":"3","key":"pmed.1003630.ref008","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.1016\/S2352-3018(15)00251-9","article-title":"A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study","volume":"3","author":"G Chamie","year":"2016","journal-title":"Lancet HIV"},{"issue":"10","key":"pmed.1003630.ref009","doi-asserted-by":"crossref","first-page":"e0186316","DOI":"10.1371\/journal.pone.0186316","article-title":"Reaching the \u2019first 90\u2032: Gaps in coverage of HIV testing among people living with HIV in 16 African countries","volume":"12","author":"S Staveteig","year":"2017","journal-title":"PLoS ONE"},{"issue":"4","key":"pmed.1003630.ref010","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1007\/s10461-019-02414-x","article-title":"A Systematic Review of Interventions that Promote Frequent HIV Testing","volume":"23","author":"MM Paschen-Wolff","year":"2019","journal-title":"AIDS Behav"},{"issue":"Suppl 3","key":"pmed.1003630.ref011","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1080\/09540121.2016.1164805","article-title":"Community perceptions of repeat HIV-testing: experiences of the ANRS 12249 Treatment as Prevention trial in rural South Africa","volume":"28","author":"J Orne-Gliemann","year":"2016","journal-title":"AIDS Care"},{"issue":"1","key":"pmed.1003630.ref012","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1257\/aer.89.1.103","article-title":"Doing it now or later","volume":"89","author":"T O\u2019Donoghue","year":"1999","journal-title":"Am Econ Rev"},{"issue":"6107","key":"pmed.1003630.ref013","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1126\/science.1222426","article-title":"Some consequences of having too little","volume":"338","author":"AK Shah","year":"2012","journal-title":"Science (New York, NY)"},{"issue":"6186","key":"pmed.1003630.ref014","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1126\/science.1232491","article-title":"On the psychology of poverty","volume":"344","author":"J Haushofer","year":"2014","journal-title":"Science (New York, NY)"},{"issue":"5","key":"pmed.1003630.ref015","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s10461-013-0588-8","article-title":"Incentivizing HIV\/STI Testing: A Systematic Review of the Literature","volume":"18","author":"R Lee","year":"2013","journal-title":"AIDS Behav"},{"issue":"7","key":"pmed.1003630.ref016","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1001\/jama.2014.9087","article-title":"Effect of providing conditional economic compensation on uptake of voluntary medical male circumcision in Kenya: a randomized clinical trial","volume":"312","author":"H Thirumurthy","year":"2014","journal-title":"JAMA"},{"issue":"5","key":"pmed.1003630.ref017","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1257\/aer.98.5.1829","article-title":"The Demand for, and Impact of, Learning HIV Status","volume":"98","author":"RL Thornton","year":"2008","journal-title":"Am Econ Rev"},{"issue":"2","key":"pmed.1003630.ref018","doi-asserted-by":"crossref","first-page":"263","DOI":"10.2307\/1914185","article-title":"Prospect theory: an analysis of decision under risk","volume":"47","author":"D Kahneman","year":"1979","journal-title":"Econometrica"},{"key":"pmed.1003630.ref019","doi-asserted-by":"crossref","first-page":"e522","DOI":"10.1136\/bmj.e522","article-title":"Commitment contracts as a way to health","volume":"344","author":"SD Halpern","year":"2012","journal-title":"BMJ (Clinical research ed)"},{"issue":"22","key":"pmed.1003630.ref020","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1056\/NEJMoa1414293","article-title":"Randomized trial of four financial-incentive programs for smoking cessation","volume":"372","author":"SD Halpern","year":"2015","journal-title":"N Engl J Med"},{"issue":"22","key":"pmed.1003630.ref021","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1001\/jama.2008.804","article-title":"Financial incentive-based approaches for weight loss: a randomized trial","volume":"300","author":"KG Volpp","year":"2008","journal-title":"JAMA"},{"issue":"5","key":"pmed.1003630.ref022","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.amepre.2013.06.020","article-title":"Commitment contracts and team incentives: a randomized controlled trial for smoking cessation in Thailand","volume":"45","author":"JS White","year":"2013","journal-title":"Am J Prev Med"},{"key":"pmed.1003630.ref023","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1257\/app.2.4.213","article-title":"Put Your Money Where Your Butt Is: A Commitment Contract for Smoking Cessation","volume":"2","author":"X Gin\u00e9","year":"2010","journal-title":"Am Econ J Appl Econ"},{"issue":"5","key":"pmed.1003630.ref024","doi-asserted-by":"crossref","first-page":"e0233600","DOI":"10.1371\/journal.pone.0233600","article-title":"A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda","volume":"15","author":"G Chamie","year":"2020","journal-title":"PLoS ONE."},{"key":"pmed.1003630.ref025","unstructured":"Uganda. Uganda HIV\/AIDS Country Progress Report July 2016-June 2017. Available from: https:\/\/www.unaids.org\/sites\/default\/files\/country\/documents\/UGA_2018_countryreport.pdf. Last accessed August 26, 2019. 2017."},{"key":"pmed.1003630.ref026","first-page":"1","article-title":"HIV retesting and risk behaviors among high-risk, HIV-uninfected adults in Uganda","volume":"2020","author":"K Marson","journal-title":"AIDS Care"},{"key":"pmed.1003630.ref027","unstructured":"The World Bank. Available from: https:\/\/data.worldbank.org\/indicator\/NY.GDP.PCAP.CD?locations=UG. [cited 2021 March 21]."},{"issue":"434","key":"pmed.1003630.ref028","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1080\/01621459.1996.10476902","article-title":"Identification of Causal Effects Using Instrumental Variables","volume":"91","author":"J Angrist","year":"1996","journal-title":"J Am Stat Assoc"},{"key":"pmed.1003630.ref029","unstructured":"HIV Prevention 2020 Road Map: Accelerating HIV prevention to reduce new infections by 75%. In: UNAIDS, editor. Geneva, Switzerland, 2020."},{"issue":"11","key":"pmed.1003630.ref030","doi-asserted-by":"crossref","first-page":"e1002458","DOI":"10.1371\/journal.pmed.1002458","article-title":"Direct provision versus facility collection of HIV self-tests among female sex workers in Uganda: A cluster-randomized controlled health systems trial","volume":"14","author":"K Ortblad","year":"2017","journal-title":"PLoS Med"},{"issue":"8","key":"pmed.1003630.ref031","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1093\/heapol\/czw035","article-title":"Expanding HIV testing and counselling into communities: Feasibility, acceptability, and effects of an integrated family planning\/HTC service delivery model by Village Health Teams in Uganda","volume":"31","author":"A Brunie","year":"2016","journal-title":"Health Policy Plan"},{"issue":"4","key":"pmed.1003630.ref032","doi-asserted-by":"crossref","first-page":"e0153612","DOI":"10.1371\/journal.pone.0153612","article-title":"Effect of Text Message, Phone Call, and In-Person Appointment Reminders on Uptake of Repeat HIV Testing among Outpatients Screened for Acute HIV Infection in Kenya: A Randomized Controlled Trial","volume":"11","author":"PM Mugo","year":"2016","journal-title":"PLoS ONE"},{"issue":"1","key":"pmed.1003630.ref033","doi-asserted-by":"crossref","first-page":"e1002719","DOI":"10.1371\/journal.pmed.1002719","article-title":"HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: An adaptive multi-arm, multi-stage cluster randomised trial","volume":"16","author":"AT Choko","year":"2019","journal-title":"PLoS Med"},{"issue":"11","key":"pmed.1003630.ref034","doi-asserted-by":"crossref","first-page":"e25636","DOI":"10.1002\/jia2.25636","article-title":"Incentives conditioned on tenofovir levels to support PrEP adherence among young South African women: a randomized trial","volume":"23","author":"CL Celum","year":"2020","journal-title":"J Int AIDS Soc"},{"issue":"8","key":"pmed.1003630.ref035","first-page":"e25588","article-title":"Uptake and retention on HIV pre-exposure prophylaxis among key and priority populations in South-Central Uganda","volume":"23","author":"J Kagaayi","journal-title":"J Int AIDS Soc. 2020"},{"issue":"4","key":"pmed.1003630.ref036","doi-asserted-by":"crossref","first-page":"e249","DOI":"10.1016\/S2352-3018(19)30433-3","article-title":"Uptake, engagement, and adherence to pre-exposure prophylaxis offered after population HIV testing in rural Kenya and Uganda: 72-week interim analysis of observational data from the SEARCH study","volume":"7","author":"CA Koss","year":"2020","journal-title":"Lancet HIV."}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1003630","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T00:00:00Z","timestamp":1621296000000}}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003630","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,18]],"date-time":"2021-05-18T20:04:27Z","timestamp":1621368267000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003630"}},"subtitle":[],"editor":[{"given":"Ruanne V.","family":"Barnabas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,5,4]]},"references-count":36,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003630","relation":{"new_version":[{"id-type":"doi","id":"10.1371\/journal.pmed.1003630","asserted-by":"object"}]},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,4]]}}}