Nudges and Incentives for HIV Testing: A Field Experiment in Ecuador

Many individuals with HIV/AIDS are not receiving treatment, in part because they are not aware of their status. The CDC and other health agencies recommend that all individuals be routinely tested for HIV/AIDS. Underdetection is particularly concerning in low- and middle-income countries because the transmission of the disease can stretch scarce public health resources. We conduct a randomized controlled field experiment in Ecuador, in a province that carries a disproportionate burden of HIV/AIDS. The overall goal of the study is to compare the effects of different strategies, namely information, a behavioral nudge (soft-commitment), and a $ 10 financial incentive (paid either at the time of testing or when the participant picks up their test results) in inducing voluntary HIV testing. In our study, we test these various strategies on a broad target population recruited in several well-transited locations in a major city in the province. Behavioral nudges and rewards have the potential to induce individual testing by overcoming psychological biases or bridging information gaps, and by overcoming social stigma concerns. Participant recruitment is in progress and is expected to be completed by December, 2017. Outcomes include percentage of participants deciding to get tested, percentage of participants picking up their test results, and percentage of participants being diagnosed with HIV. Preliminary results indicate that: 1. About 15% of subjects provided with "information only" agreed to get tested; 2. The "soft-commitment" opportunity did not have additional effects; 3. The $10 incentive paid at the time of testing increased the fraction of subjects who got tested to 60%; 4. The $10 incentive paid when the participants picked up their test results, instead, did not show any additional effect; 5. Between 1.5% and 2% of individual tested were HIV positive; 6. About 40% of non-incentivized subjects chose to learn their test results, vs. 20% of participants who received the incentive at the time of testing. Our preliminary results indicate that incentives provided at the time of testing can overcome economic or psychological barriers to get tested, although the relatively low proportion of incentivized subjects who chose to pick up their test results suggests that other strategies need to be devised to motivate individuals to learn their HIV status.