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Brown University Researchers Find that Providing a Lottery Incentive May Encourage Dual Use of Contraception and Condoms in Pilot Trial in South Africa

Can providing a lottery incentive help promote the use of safe sex practices? Dr. Omar Galarraga, an associate professor of health services and policy at the Brown University School of Public Health and Dr. Abigail Harrison, an associate professor of behavioral and social sciences also at Brown and their colleagues at The University Of Cape Town, South Africa set out to see if providing lottery incentives in South Africa would encourage the use of dual protection – that is use of contraception and a barrier method, like a condom.  They found that use of a lottery incentive resulted in higher use of condoms and higher dual protection use, a critically important prevention strategy in the high HIV prevalence setting of South Africa.

100 women, aged 18-40, who were seeking post abortion care in Cape Town, South Africa were recruited for a randomized control trial called Empower Nudge. After choosing their preferred contraceptive method, Participants were assigned to two groups and were followed for six months. One group of women received compensation for their transportation costs after each visit (first visit, three months and six months), while one group received compensation plus the chance to be entered into a lottery. The latter group received a lottery ticket at three months after contraception use was confirmed, and after six months when use of dual protection was confirmed.

They found that the group that was entered into the lottery were more likely to return to the two follow up meetings. They were 6 times more likely to return at three months and 5 times more likely to return at six months. This group was also 4 times more likely to use condoms at the three-month period and were twice as likely to do so at the six-month period. In terms of dual protection use, the lottery group was 3 times more likely to use dual protection at three months than the other group but slightly less likely at six months. Both six-month findings were not statistically significant.

Conditional lotteries have been used for the purposes of public health in the past, specifically for encouraging people to get tested for HIV, but the authors stress that while the results of their study show a positive correlation between the use of a lottery and desired health behaviors, more research, conducted over a longer period of time with more participants, is needed to fully understand the effectiveness of this approach.