Using Incentives and Nudging to Improve Non-Targeted HIV Testing in Ecuador: A Randomized Trial

Mario Macis, Michelle Grunauer, Erika Gutierrez, Ricardo Izurieta, Phillip Phan, Miguel Reina Ortiz, Carlos Rosas, Enrique Teran

Research output: Contribution to journalArticlepeer-review


Under-detection of HIV/AIDS still burdens many low- and middle-income countries (LMICs). Our randomized trial investigated the effects of financial incentives and a behavioral nudge to induce HIV testing and learning HIV status in Ecuador. In the control group, 12.2% of participants agreed to testing, and 5.3% learned results. A financial incentive paid at testing increased the fraction of participants tested by 50.1 percentage points (95% CI 38.8 to 61.4) and the fraction who learned their status by 8.9 percentage points (95% CI 5.3 to 12.5); the nudge had no effect. The HIV-positive rate was 1.2% in the control group, and incentives prompted a 4.7 percentage point (95% CI 0.5 to 8.9) higher proportion of HIV-positive detection. Incentives also induced earlier testing, suggesting reduced procrastination. This suggests that information with appropriately timed small financial incentives can improve HIV testing and detection of new cases in the general population in LMIC settings.

Original languageEnglish (US)
Pages (from-to)2542-2550
Number of pages9
JournalAIDS and behavior
Issue number8
StatePublished - Aug 2021


  • Behavioral nudges
  • Cost analysis
  • Ecuador
  • Ethnic minority
  • HIV
  • Incentives
  • Testing

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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