Using behavioural insights to increase HIV self-sampling kit returns: a randomized controlled text message trial to improve England's HIV self-sampling service

Laura Brown*, K. S. Tan, L. E. Guerra, C. J. Naidoo, A. Nardone

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Objectives: The aim of the study was to determine whether behaviourally informed short message service (SMS) primer and reminder messages could increase the return rate of HIV self-sampling kits ordered online. Methods: The study was a 2 × 2 factorial design randomized control trial. A total of 9585 individuals who ordered a self-sampling kit from different SMS combinations: 1) standard reminders sent days 3 and 7 after dispatch (control); 2) primer sent 1 day after dispatch plus standard reminders; 3) behavioural insights (BI) reminders (no primer); or 4) primer plus BI reminders. The analysis was restricted to individuals who received all messages (n = 8999). We used logistic regression to investigate independent effects of the primer and BI reminders and their interaction. We explored the impact of sociodemographic characteristics on kit return as a secondary analysis. Results: Those who received the primer and BI reminders had a return rate 4% higher than that of those who received the standard messages. We found strong evidence of a positive effect of the BI reminders (odds ratio 1.13; 95% confidence interval 1.04–1.23; P = 0.003) but no evidence for an effect of the primer, or for an interaction between the two interventions. Odds of kit return increased with age, with those aged ≥ 65 years being almost 2.5 times more likely to return the kit than those aged 25–34 years. Men who have sex with men were 1.5–4.5 times more likely to return the kit compared with other sexual behaviour and gender identity groups. Non-African black clients were 25% less likely to return the kit compared with other ethnicities. Conclusions: Adding BI to reminder messages was successful in improving return rates at no additional cost.

Original languageEnglish
Pages (from-to)585-596
Number of pages12
JournalHIV Medicine
Issue number9
Publication statusPublished - Oct 2018

Bibliographical note

Funding Information:
The study was registered with (trial registration number: researchregistry1963). PHE covered the costs of the HIV self-sampling kits from 21 November 2016 to 10 January 2017. The authors wish to thank Tim Alston from Preventx (the service provider) for collecting and providing the trial data. HIV self-sampling steering group: Peter Taylor, Simon How, Louise Logan, John Dunn, Noel Gill, Carol Ford, Tim Alston, Robert Carroll, Stephen Jones, Kirsty Foster, Lesley Talbot, Helen Robinson, Stephen Nicholson and Tony Lacey. Conflicts of interest: There are no conflicts of interest. Finiancial disclosure: All funding came from Public Health England (PHE).

Publisher Copyright:
© 2018 The Authors. HIV Medicine Published by John Wiley & Sons Ltd on behalf of British HIV Association


  • HIV diagnostic tests
  • behavioural interventions
  • public health
  • randomized controlled trial
  • text messaging


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