LIFT: Leveraging Incentives For Testing
LIFT: Leveraging Incentives For Testing
This project seeks to increase the number of HIV positive adolescents ages 15-19 years in Region F of Johannesburg who know their HIV infection status and are linked to treatment and care. The rate of new HIV infections has declined or stabilized in many populations, yet over a third of new HIV infections continue to occur among 15-24 year olds, and only half of South Africans in this age group have ever been tested for HIV. There is increasing interest in the role of incentives to modify health behaviors and encourage testing. Meanwhile, there is growing evidence that mobile platforms are an acceptable and feasible channel for the delivery of health promotion interventions, including sexual health promotion. The iloveLife program combines a sexual health promotion intervention delivered through a mobile platform with incentives to achieve sustained use and encourage positive behavior change including HIV testing. This project proposes to use and evaluate iloveLife to incentivize HCT uptake, refer adolescents to adolescent-friendly testing services near them, and identify and target areas of high adolescent concentration with mobile testing services, all to increase adolescents’ testing rates and HIV case finding and provide a scalable model for effective HIV testing.
The LIFT project seeks to increase the number of HIV positive adolescents ages 15-24 years in Region F of Johannesburg who know their HIV infection status and are linked to treatment and care. It will identify geographic 'hotspots' of adolescents at high-risk of being HIV positive.
1000 young people (15-24 years old) in study
While the rate of new HIV infections has declined or stabilized in many populations, over a third of new HIV infections continue to occur among 15-24 year olds. HIV incidence is characterized by marked gender and regional disparities with twothirds of new HIV infections in adolescents occurring in young women and girls living in sub-Saharan Africa. Global estimates suggest that comprehensive accurate knowledge about HIV, condom use, HIV testing, and anti-retroviral treatment (ART) coverage in adolescents is low in most countries. UNAIDS has documented that adolescents were the only group in which HIV-associated mortality is not decreasing, suggesting inadequate access to ART In South Africa, HIV prevalence continues to rise. By age 20-24 years, HIV prevalence in young women is 17%, three-fold higher than the men in the same age group, and three-fold higher than the 15-19 year age group, pointing to high rates of new infection in young women. Worrying behavioral trends in the most recent population based survey suggest ongoing sexual transmission, particularly in the 15-24 year age group. In 2012, increases were observed in early sexual debut, age-disparate partnerships and multiple sexual partners (MSP) in this age group, while more young women reported age-disparate partnerships and sex with a partner five years her senior. While condom use at last sex was reported by 58% of those aged 15-24, this was a decline from previous national surveys. In addition to HIV, unsafe sex is also associated with the risk of unintended pregnancy and/or sexually transmitted infections. High rates of both have been observed in populations aged 15-24 in South Africa.
Given high levels of risk and vulnerability in youth, interventions are urgently needed that can link young people to SRH/HIV treatment and prevention services. Knowledge of service availability and location appears to be high, yet uptake of services is comparatively low. Despite being immigrants, most residents reside in Region F for prolonged periods in search of employment opportunities. The physical and social environment in region F have a profound impact on the health and well-being of people who live there, particularly adolescents. Overall HCT targets in the larger Johannesburg district fall short of the national target of 36% of South Africans ages 15-49 testing for HIV each year, with just 12.8% of residents tested in 2013/14. Despite low testing, the district has a significant HIV positive population. Region F has a high number of adults on ART and the second largest population of children receiving ART among all health districts in South Africa (10,065).