Improving HIV testing amongst adolescents through an integrated Youth Centre rewards program: Insights from South Africa

Despite high HIV prevalence the uptake of HIV counseling and testing (HCT) has been low in South African adolescents, in particular among boys. We designed and implemented an integrated Youth Centre (YC), which included a health clinic and a points based rewards program to incentivize YC services, adjacent to a peri-urban community in Cape Town. We compared 12 month age and gender specific HCT rates for 12-22 year olds between the YC and the single local community clinic in the adjacent community prospectively and for the 12 months prior to YC implementation. Local clinic data were collected through the HCT register. At the YC demographic, attendance, incentives and HIV testing data were prospectively collected via a biometric data collection system. 1187 12-22 year olds attended the YC in the 12 month period. Within the 12-15 year old age group, 12.7% more individuals tested at the YC compared to the clinic in 2011-2012; this difference was greater in males than females. In the 16-22 year category, significantly more individuals tested at the clinic compared to the YC. The use of the YC reward program was associated with undergoing an HIV test. Understanding the specific programmatic factors that led to increased testing behaviour including the role of incentives at the YC warrants further attention.