A Savings Intervention to Reduce Men's Engagement in HIV Risk Behaviors

Study Overview
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Brief Summary
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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
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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.

Official Title
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A Savings Intervention to Reduce Men's Engagement in HIV Risk Behaviors

Conditions
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Human Immunodeficiency Virus, STI, Alcohol Consumption, Incentives, Behavior

Intervention / Treatment
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* Behavioral: Receives mobile banking account with incentives to save


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 39 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional 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.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mobile banking account with incentives to save<br>Participants in the savings intervention group will be provided with basic information on the importance of saving for the future, as well as (a) lottery-based incentives to save, (b) opportunities to develop savings goals, and (c) periodic reminders about the savings incentives and goals. Participants will receive assistance in opening and using a mobile savings account and will receive an education session that emphasizes the importance of saving for the future. Participants will be told about lottery-based incentives for saving money in their account. | Behavioral: Receives mobile banking account with incentives to save<br>* 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.<br>|
| No Intervention: Basic health and financial education<br>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. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of HIV and other STIs | 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. | 24 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Expenditures on alcohol | Money spent on alcohol. | 6 month intervals | 
| Expenditures on transactional sex | Money, goods, and services spent on transactional sex (defined broadly to include financial and non-financial transfers to commercial and non-commercial sexual partners). | 6 month intervals | 
| Expenditures on gambling | Money spent on gambling. | 6 month intervals | 
| Number of sexual partners | Number of sexual partners participant had in the past 3 months. | 6 month intervals | 
| Recent engagement in transactional sex | Whether participant engaged in transactional sex (defined broadly to include financial and non-financial transfers to commercial and non-commercial sexual partners), or not in the past 3 months. | 6 month intervals | 
| Number of transactional sex partners | Total number of transactional sex partners participant had in the past 3 months. | 6 month intervals | 
| Number of transactional sex encounters | Number of transactional sex encounters participant engaged in during the past 3 months. | 6 month intervals | 
| Condom use at most recent sexual encounter | Whether participant used a condom or not at most recent sexual encounter in the past 3 months. | 6 month intervals | 
| Alcohol use | 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 | 6 month intervals | 
| HIV, CT, and NG incidence between 0-12 months and 12-24 months | More temporally granular measures of incidence for HIV, CT, and NG. | Up to 24 months | 
| Engagement in care among those who are HIV-positive | Whether or not participants who are HIV-positive are currently engaged in care for their HIV. | 6 month intervals | 
| Expenditures on food | Money spent on food items. | 6 month intervals | 
| Expenditures on household needs | Money spent on household needs (e.g., utilities). | 6 month intervals | 
| Savings and investment | Total savings and investment, defined as the money value of formal and informal savings as well as investments in physical and human capital. | 6 month intervals | 
| Total formal savings | The sum of savings balances in all formal bank accounts. | 6 month intervals | 
| Total household assets | Value of all assets. | 6 month intervals | 
| Expenditure on human capital investment | Money spent on human capital investment (e.g., spending on children's education). | 6 month intervals | 
| Expenditure on productive assets | Money spent on productive assets (e.g., spending on agricultural equipment). | 6 month intervals | 
| Expenditure on housing improvement | Money spent on structure of dwelling. | 6 month intervals |