The Impact of Financial Incentives on HIV Incidence Among Adolescent Girls and Young Women in Eswatini: Sitakhela Likusasa, a cluster randomised trial

This paper analyses the influence of financial incentives in education participation for the reduction of HIV  infection among adolescent girls and young women in Eswatini. For this study, HIV-negative adolescent girls and young women aged 15–22 years old, 50% of whom were out of school, were recruited from 293 clusters in Eswatini from urban (30%) and rural areas (70%) Financial incentives conditional on education attendance were randomly allocated at the cluster level. All participants were further individually randomised into eligibility for a raffle incentive conditional on random selection into the raffle, on negative tests for syphilis and Trichomonas vaginalis and on being a raffle winner, creating four subarms in a 2×2 factorial design: no-intervention, raffle incentive, education incentive and raffle & education incentive. Logistic regressions were used in intention-to-treat analysis of HIV incidence over 3 years to estimate the impact of incentives conditional on school attendance and raffle incentives conditional on remaining sexually transmitted infection free.

The study concludes that financial incentives conditional on education participation significantly reduced HIV infection among adolescent girls and young women in Eswatini and appear to be a promising tool for prevention in high HIV prevalence settings.