Skip to main content


Log in

Effectiveness of Behavioural Economics Informed Interventions for the Prevention, Screening, and Antiretroviral Treatment of HIV Infection: A Systematic Review of Randomized Controlled Trials

  • Substantive Review
  • Published:
AIDS and Behavior Aims and scope Submit manuscript


Failure to meet international targets set for the human immunodeficiency virus HIV pandemic suggests that more effective public health strategies are needed. New strategies informed by behavioural economics are now increasingly being tested, with promising results. However, the evidence base is diverse and challenging for policymakers to interpret. This paper aims to synthesise existing evidence by reporting results from a systematic review of behavioural economics-based interventions for addressing HIV prevention, testing and treatment. The reported study was a systematic review of randomized controlled trials. The search was conducted in four electronic medical literature databases, six trial registries, four grey literature sources and was not restricted to any country or region. Bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews; quality of evidence was assessed using GRADE methodology. Fifteen full text articles were included in the final analysis. The synthesis of these studies revealed that strategies involving opt-out defaults, active-choice defaults, and lottery incentives can potentially increase uptake of HIV testing. Lottery incentives also showed signs of effectiveness in improving HIV prevention, ART adherence and initiation. Despite the promising findings, the overall evidence was judged to be of moderate to very low quality. Behavioural economics-based interventions are promising behavioural change strategies, although more well-designed studies are needed to strengthen the evidence base.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Data Availability

The detailed search strategies used for this systematic review are available in the form of supplementary materials.


  1. Longo D, Fauci A, Kasper D, Hauser S, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. 18th ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  2. HIV/AIDS Fact Sheet. 2021. Available from:

  3. Fast-Track—Ending the AIDS epidemic by 2030. 2014. Available from: Accessed 18 May 2021.

  4. 2025 AIDS TARGETS—UNAIDS. 2020. Available from:

  5. GBD Compare | IHME Viz Hub. Available from: Accessed 18 May 2021.

  6. Thaler RH, Sunstein CR. Nudge: Improving decisions about health, wealth, and happiness. New Haven: Yale University Press; 2008.

    Google Scholar 

  7. Tremewan J. Behavioral economics: toward a new economics by integration with traditional economics, by Masao Ogaki and Saori C. Tanaka (Springer Nature, Singapore, 2017). Econ Rec. 2020;96(313):221.

    Article  Google Scholar 

  8. Choko AT, Corbett EL, Stallard N, et al. HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: an adaptive multi-arm, multi-stage cluster randomised trial. PLoS Med. 2019;16(1): e1002719.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kranzer K, Simms V, Bandason T, et al. Economic incentives for HIV testing by adolescents in Zimbabwe: a randomised controlled trial. Lancet HIV. 2018;5(2):e79–86.

    Article  PubMed  Google Scholar 

  10. Chamie G, Schaffer EM, Ndyabakira A, et al. Comparative effectiveness of novel nonmonetary incentives to promote HIV testing. AIDS. 2018;32:1443–51.

    Article  PubMed  Google Scholar 

  11. Galárraga O, Sosa-Rubí SG. Conditional economic incentives to improve HIV prevention and treatment in low-income and middle-income countries. Lancet HIV. 2019;6(10):e705–14.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Galárraga O, Genberg BL, Martin RA, Barton Laws M, Wilson IB. Conditional economic incentives to improve HIV treatment adherence: literature review and theoretical considerations. AIDS Behav. 2013;17(7):2283–92.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Operario D, Kuo C, Sosa-Rubí SG, Gálarraga O. Conditional economic incentives for reducing HIV risk behaviors: integration of psychology and behavioral economics. Health Psychol. 2013;32(9):932–40.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Roseleur J, Harvey G, Stocks N, Karnon J. Behavioral economic insights to improve medication adherence in adults with chronic conditions: a scoping review. Patient. 2019;12(6):571–92.

    Article  PubMed  Google Scholar 

  15. EPOC resources for review authors. 2021. Available from: Accessed 20 July 2021.

  16. Peon D, Antelo M, Calvo SA. An inclusive taxonomy of behavioral biases. Eur J Gov Econ. 2017;6:24–58.

    Article  Google Scholar 

  17. Rayyan. 2021. Available from: Accessed 15 Aug 2021.

  18. GRADE Handbook. 2021. Available from: Accessed 20 July 2021.

  19. Chamie G, Kwarisiima D, Ndyabakira A, et al. Financial incentives and deposit contracts to promote HIV retesting in Uganda: a randomized trial. PLoS Med. 2021;18(5): e1003630.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chamie G, Ndyabakira A, Marson KG, et al. A pilot randomized trial of incentive strategies to promote HIV retesting in rural Uganda. PLoS ONE. 2020;15(5): e0233600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Macis M, Grunauer M, Gutierrez E, et al. Using incentives and nudging to improve non-targeted HIV testing in Ecuador: a randomized trial. AIDS Behav. 2021;25(8):2542–50.

    Article  PubMed  Google Scholar 

  22. Kavanagh NM, Schaffer EM, Ndyabakira A, et al. Planning prompts to promote uptake of HIV services among men: a randomised trial in rural Uganda. BMJ Glob Health. 2020;5(11).

  23. Montoy JCC, William HD, Kaplan BC. Cash incentives versus defaults for HIV testing: a randomized clinical trial. PLoS ONE. 2018;13(7): e0199833.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Galárraga O, Harries J, Maughan-Brown B, et al. The Empower Nudge lottery to increase dual protection use: a proof-of-concept randomised pilot trial in South Africa. Reprod Health Matters. 2018;26(52):67–80.

    Article  Google Scholar 

  25. Bazant E, Mahler H, Machaku M, et al. A randomized evaluation of a demand creation lottery for voluntary medical male circumcision among adults in Tanzania. J Acquir Immune Defic Syndr. 2016;72(Suppl 4):280.

    Google Scholar 

  26. Thirumurthy H, Masters SH, Rao S, et al. The effects of providing fixed compensation and lottery-based rewards on uptake of medical male circumcision in Kenya: a randomized trial. J Acquir Immune Defic Syndr. 2016;72:S309.

    Article  PubMed Central  Google Scholar 

  27. MacCarthy S, Wagner Z, Mendoza-Graf A, et al. A randomized controlled trial study of the acceptability, feasibility, and preliminary impact of SITA (SMS as an Incentive To Adhere): a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda. BMC Infect Dis. 2020;20(1):173.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Stecher C, Mukasa B, Linnemayr S. Uncovering a behavioral strategy for establishing new habits: evidence from incentives for medication adherence in Uganda. J Health Econ. 2021;77: 102443.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Barnabas RV, Alastair VH, McConnell M, et al. Lottery incentives have short-term impact on ART initiation among men: results from a randomized pilot study. J Int AIDS Soc. 2020;23: e25519.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bjorkman Nyqvist M, Corno L, de Walque D, Svensson J. Using lotteries to incentivize safer sexual behavior: evidence from a randomized controlled trial on HIV prevention. World Bank policy research working paper. 2015 (7215).

  31. Hopewell S, Loudon K, Clarke MJ, Oxman AD, Dickersin K. Publication bias in clinical trials due to statistical significance or direction of trial results. Cochrane Database Syst Rev. 2009;2009.

  32. Thirumurthy H. Behavioral commitment and planning nudges to increase HIV self-testing in South Africa, plan and pledge. 2019. Available from: Accessed 20 July 2021.

  33. Hunter LA, Liu JX, Rao A, et al. Drug shops are an effective strategy to reach adolescent girls and young women with HIV self-testing and contraception: a randomized trial in Tanzania. J Int AIDS Soc. 2020;23(SUPPL 4).

  34. Bien-Gund CH, Ho JI, Bair EF, et al. Financial incentives and real-time adherence monitoring to promote daily adherence to HIV treatment and viral suppression among people living with HIV: a pilot study. J Acquir Immune Defic Syndr. 2021;87(1):688–92.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Krishnamoorthy Y, Rehman T, Sakthivel M. Effectiveness of financial incentives in achieving UNAID fast-track 90-90-90 and 95-95-95 target of HIV care continuum: a systematic review and meta-analysis of randomized controlled trials. AIDS Behav. 2021;25(3):814–25.

    Article  PubMed  Google Scholar 

  36. Wagner Z, Montoy JCC, Drabo EF, Dow WH. Incentives versus defaults: cost-effectiveness of behavioral approaches for HIV screening. AIDS Behav. 2020;24(2):379–86.

    Article  PubMed  Google Scholar 

  37. Schulz KF, Grimes DA. Blinding in randomised trials: hiding who got what. Lancet. 2002;359(9307):696–700.

    Article  PubMed  Google Scholar 

  38. Preference Collaborative RG. Patients’ preferences within randomised trials: systematic review and patient level meta-analysis. BMJ. 2008;337:a1864–a1864.

    Article  Google Scholar 

Download references


The authors are grateful to David Burns, Information Officer, Health Economics Research Unit, University of Aberdeen, for assistance with the electronic bibliographic search strategies and for proof-reading the article.


No funding was received to assist with the preparation of this manuscript.

Author information

Authors and Affiliations



All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AAA and checked for accuracy and completeness by PMN. The first draft of the manuscript was written by AAA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ahmed Abdirizak Ahmed.

Ethics declarations

Conflict of interest

The authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 63 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmed, A.A., McNamee, P. Effectiveness of Behavioural Economics Informed Interventions for the Prevention, Screening, and Antiretroviral Treatment of HIV Infection: A Systematic Review of Randomized Controlled Trials. AIDS Behav 27, 3521–3534 (2023).

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: