Alcohol Consumption, Behavior, Human Immunodeficiency Virus, Incentives, STI
Conditions
Brief summary
This randomized control trial will test an economic intervention to reduce Kenyan men's engagement in behaviors that increase the risk of HIV/STIs. Participants randomized to the intervention group will be able to open accounts with a partner bank and will be incentivized to save with lottery-based rewards.
Detailed description
This project will evaluate an innovative, theoretically-motivated economic intervention to reduce men's engagement in transactional sex and other risky behaviors. Leveraging innovations in mobile financial services and research on savings behavior in low-income countries, the investigators propose to test an intervention that seeks to motivate high-risk, income-earning men in western Kenya to reduce their spending on risky behaviors and instead save their disposable income in local bank accounts. These bank accounts will include additional incentives to save in the form of lottery-based rewards linked to amounts saved. The intervention will also encourage participants to develop savings goals and strategies, and provide periodic reminders about saving regularly. Through a direct economic mechanism (incentives to shift expenditures from the present to the future) and a psychological mechanism (increasing future orientation), the investigators hypothesize that the intervention will result in increased savings, reduced spending on transactional sex and alcohol, less risky sexual behavior, and reduced risk of HIV and sexually transmitted infections (STIs). The investigators will conduct a randomized controlled trial among men who are at high risk of HIV and STI infection and determine the effects of a savings intervention on health and economic outcomes. Specific aims of the project are as follows. Aim 1: Determine the impact of the intervention on savings and investment behavior, self-reported sexual behavior, and incidence of HIV/STIs. Aim 2: Quantitatively and qualitatively assess mechanisms of behavior change among participants and a sample of their female partners.
Interventions
BEHAVIORALReceives mobile banking account with incentives to save
Participants will receive assistance in opening and using a mobile savings account, will be given education emphasizing saving practices and will be told about lottery-based incentives opportunities.
OTHERBasic Health and financial education
Participants in the control group will be given basic information on the importance of saving for the future. In addition, health education curriculum developed by Impact Research \& Development Organization (IRDO) will be provided to participants with standard health education on places to seek services for HIV and STI prevention and treatment, including information on alcohol and transactional sex as risk factors for HIV transmission.
Sponsors
University of Pennsylvania
Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Impact Research & Development Organization
University of California, San Francisco
University of Washington
RTI International
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
In Kenyan communities with high HIV/STI prevalence, men will be randomized to two groups: a control group that receives basic health and financial education or a savings intervention group that receives a mobile banking account with incentives to save.
Eligibility
Sex/Gender
MALE
Age
18 Years to 39 Years
Healthy volunteers
Yes
Inclusion criteria
* Male * Age 18-39 years * Resides in study community and plans to remain for the next 2 years * Used alcohol or other substances in the past month * Engagement in any transactional sex (defined as payment of money, goods, or services in exchange for sex) in the past 3 months * Has a steady income source that typically results in earnings every week * Owns mobile phone * Already has or is willing to open an account with partner banking institution * Has national identification card (required for opening bank account) * Has Kenya Revenue Authority personal identification number or is willing to create one (required for opening bank account)
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of HIV and Other STIs | 24 months | Composite incidence of at least one of HIV or other STIs (herpes simplex virus type 2 (HSV-2), Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT)) over 24 months. The investigators will combine all STIs (including HIV) into a composite variable, with each participant counting once. For participants who are HIV-positive at baseline or HSV-2-positive, the outcome will be defined over all STIs other than HIV. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Expenditures on Alcohol (Self and Others) | 24 months | Money spent on alcohol during a 6 month period (2022 USD, winsorized at the 95th percentile) |
| Expenditures on Transactional Sex | 24 month | Money, goods, and services spent on transactional sex (defined broadly to include financial and non-financial transfers to commercial and non-commercial sexual partners) during a 6 month period (2022 USD, winsorized at the 95th percentile) |
| Expenditures on Gambling | 24 month | Money spent on gambling during a 6 month period (2022 USD, winsorized at the 95th percentile) |
| Number of Sexual Partners | 24 month | Number of sexual partners participant had in the past 3 months. |
| Participant Engaged in Transactional Sex in the Last 3 Months | 24 month | Participant engaged in transactional sex (defined broadly to include renumerating someone via financial and non-financial transfers for sexual activities), in the past 3 months (binary yes=1/no=0). The question from the survey: "In the past 3 months, have you exchanged money, goods, gifts, food (including fish), housing or services for sex?" |
| Number of Transactional Sex Partners | 24 month | Total number of transactional sex partners participant had in the past 3 months. |
| Number of Transactional Sex Encounters | 24 month | Number of transactional sex encounters participant engaged in during the past 3 months (winsorized at the 95th percentile). |
| Participant Used Condom at Most Recent Sexual Encounter in the Past 3 Months | 24 month | Participant used a condom at most recent sexual encounter in the past 3 months (binary: yes=1/no=0). The question from the survey: "In your last sexual encounter in the past 3 months, did you use a condom?" |
| Alcohol Use (Hazardous Drinking) | 24 month | As measured by the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale. The AUDIT-C is scored on a scale of 0-12, and higher values mean worse outcomes. We measure hazardous drinking, as indicated by an AUDIT-C score \>=4. |
| Expenditures on Food | 24 month | Money spent on food items during a 6-month period (2022 USD, winsorized at the 95th percentile) |
| Expenditures on Household Needs | 24 month | Money spent on household needs (including personal items; clothing and shoes; household items; utilities; and transport) during a 6-month period (2022 USD, winsorized at the 95th percentile) |
| Savings and Investment | 24 months | Total savings and investment, defined as the money value of formal and informal savings as well as investments in physical and human capital. |
| Total Informal Savings | 24 month | The sum of savings held outside of formal institutions, including savings groups and money saved at home or elsewhere |
| Total Formal Savings | 24 month | The sum of savings balances in all formal bank accounts. |
| Total Household Assets | 24 month | Value of all assets (2022 USD, winsorized at the 95th percentile). |
| Expenditure on Human Capital Investment | 24 month | Money spent on human capital investment (e.g., spending on children's education) during a 6-month period (2022 USD, winsorized at the 95th percentile) |
| Housing Improved in the Past 6 Months | 24 months | Housing was improved in the past 6 months, e,g, repaired or constructed home's walls, roof, floor, toilet source, or drinking water source (yes=1/no=0). The question from the survey: "Have you made any additions or improvements to your house in the last 6 months? For example, have you repaired or constructed your home's walls, roof, floor, toilet source, drinking water source?" |
| Perpetuation Intimate Partner Violence | 24 month | Perpetuation of physical, psychological, or sexual IPV |
| Experienced Intimate Partner Violence | 24 month | Experienced physical, psychological, or sexual IPV |
| Perceived Financial Security | 24 month | Financial wellbeing scale is a 10 item scale (Fu, J. (2020). Ability or opportunity to act: what shapes financial well-being?. World Development, 128, 104843). The scale is called the financial wellbeing scale. The total score ranges from 1 to 8 with lower values indicating poorer financial wellbeing. |
| Food Security | 24 month | 3 item scale from Household Food Insecurity Access Scale. 0 to 9 with higher scores indicating higher food insecurity |
| Stress | 24 month | Cohen's Perceived Stress Scale, PSS. 0 to 40 with higher scores indicating higher perceived stress |
| Stress, Helplessness | 24 month | Perceived helplessness score (subscale of PSS). 0 to 24 with higher scores indicating higher helplessness |
| Stress, Self-efficacy | 24 month | Perceived self-efficacy score (subscale of PSS). 0 to 16 with higher scores indicating higher self-efficacy |
| Most Future Oriented | 24 month | Assessed by a commonly-used scale that asks participants to make hypothetical choices between money received at two different times (e.g., 1,000 Shillings in 1 month vs. 1,100 Shillings in 2 months). Based on their responses participants are grouped into one of four ordinal groups that range from least to most future oriented. This was then binarized into the most future oriented group (category 4) versus less future oriented (categories 1 through 3). |
| Future Orientation, Well Being | 24 month | Cantril scale which measures participant's well-being. 0 to 10 with higher scores indicating higher well being |
| Future Orientation, Longevity | 24 month | 11-point scale that assesses participant's expectations about their longevity. 0 to 10 with higher scores indicating higher expectations about longevity |
Countries
Kenya
Contacts
PRINCIPAL_INVESTIGATORHarsha Thirumurthy, PhD
University of Pennsylvania
Participant flow
Pre-assignment details
Participants completed the baseline survey after screening and were randomized at the end of the survey.
Baseline characteristics
| Characteristic | — |
|---|---|
| Age, Continuous | 27.9 years STANDARD_DEVIATION 5.1 |
| Married or living as married | 466 Participants |
| Race and Ethnicity Not Collected | 0 Participants |
| Region of Enrollment Kenya | 749 participants |
| Sex: Female, Male Female | 0 Participants |
| Sex: Female, Male Male | 749 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 5 / 751 | 11 / 749 |
| other Total, other adverse events | 0 / 751 | 0 / 749 |
| serious Total, serious adverse events | 0 / 751 | 0 / 749 |
Outcome results
None listed