Evaluating the Effectiveness of Incentives to Improve HIV Prevention Outcomes for Young Females in Eswatini: Sitakhela Likusasa Impact Evaluation Protocol and Baseline Results
Abstract Background: Eswatini continues to have the highest prevalence of HIV in the world, and one of the highest HIV incidences among adult populations (aged 15-49). This analysis reports on both key elements of study design/protocol and baseline results from an impact evaluation of an intervention incentivizing (i) initiation or enrolment into some form of education, attendance at or completion of this form of education, and (ii) lower risk sexual behaviour. Methods: The impact evaluation employs a two by two factorial design in which participants are enrolled in either the incentive for education arm (‘education treatment arm’) or the control arm (‘education control arm’). In each of these arms, 50% of participants were randomized to also be eligible for selection – three times a year – to participate in a conditional raffle. Results: Baseline recruitment and screening occurred in 2016 when a total of 6,055 individuals were screened of which 4,863 participated in the baseline survey, and 4,819 individuals were randomized into one of the study arms. The baseline prevalence of HIV, Trichomonas vaginalis, and syphilis among adolescent girls and young women (AGYW) 8.20% (397/4,840), 3.31% (150/4,533) and 0.17% (8/4,830) respectively. Conclusions: An educational cash incentive and raffle incentive impact evaluation that addresses adolescent girls and young women who are in-education and out-of-education has the potential to reduce HIV risk in adolescent girls and young women in Eswatini.