Healthcare Workers' Perspectives on Financial Incentives to Increase Pediatric HIV Testing

Abstract

University of Washington Abstract Healthcare Workers’ Perspectives on Financial Incentives to Increase Pediatric HIV Testing Dana Atkins Chair of the Supervisory Committee: Grace John-Stewart Departments of Epidemiology, Global Health, Medicine & Pediatrics Background: Financial incentives (FI) have been used to modify health behavior. The Financial Incentives to Increase Uptake of Pediatric HIV Testing in Kenya (FIT) study is a 5-arm randomized controlled trial (NCT03049917) that showed that FI increased pediatric HIV testing uptake among children of unknown HIV status. Translating evidence-based interventions to scale requires an implementation science approach. Methods: We conducted six focus group discussions (FGDs) with 52 healthcare workers (HCWs) to assess perspectives on acceptability, feasibility and sustainability of FI scale-up for pediatric HIV testing. Question guides were based on the Consolidated Framework for Implementation Research (CFIR). Participants were recruited from facilities in Kisumu, Kenya where the FIT study was conducted. Purposive sampling was used to enroll a range of HCW cadres. Data was analyzed using descriptive thematic analysis to characterize and map key determinants influencing HCW perceptions of FI. Results: HCWs found the use of FI interventions to motivate pediatric HIV testing as highly acceptable. HCWs believed FI were advantageous compared to currently employed strategies because they overcame cost barriers associated with testing and provided additional motivation to test beyond health reasons. While HCWs noted the relative advantage of FI, there were concerns about how the intervention would be implemented that influenced HCW perceptions of feasibility and sustainability. HCWs expressed concern that FI for testing may negatively affect further care due to families expecting repeated FI support and wondered if FI would lead to caregivers bringing unrelated children for testing. Other issues discussed included: concerns of inequity given that other key populations (adults/adolescents) would not receive FI for testing and clinic infrastructure to support FI. HCWs suggested that for future program roll-out success, it was necessary to clearly define the target population, create a database system for tracking index case HIV testing, and provide incentives to HCWs. Conclusion: HCWs viewed FI as an acceptable testing strategy to increase uptake of pediatric testing. To ensure feasibility and sustainability of FI interventions for pediatric HIV testing, it will be important to clearly define target population, manage expectations of continued financial support, and establish systems to track testing.