Financial incentives improve HIV viral suppression, retention in care
Financial incentives improved viral suppression and retention in care in adults beginning HIV treatment in Tanzania, according to results from a randomized controlled trial published in The Lancet HIV.
“These findings contribute to a gap in understanding the effects of financial incentives on a biomarker of HIV treatment adherence,” Carolyn A. Fahey, MPH, of the University of California, Berkeley School of Public Health’s division of epidemiology, and colleagues wrote. “To our knowledge, this is the first randomized trial in a low-income and middle-income country (LMIC) to evaluate the effect of financial incentives for treatment-seeking behavior on HIV viral suppression in a general population.”
Fahey and colleagues enrolled 530 adults from four health facilities in the Shinyanga region of Tanzania who had initiated ART within the past 30 days. They randomly assigned 184 participants to a control group, 172 to a smaller incentive group that was given the equivalent of $4.50 for monthly clinic attendance, and 174 to a larger incentive group that was given the equivalent of $10 for monthly clinic attendance.
Monetary incentives were delivered to participants via mobile health technology (mHealth). Outcome of retention care with viral suppression was the study’s primary outcome.
At 6 months, 73% of participants in the control group, 83% (risk difference [RD] = 9.8; 95% CI, 1.2-18.5) of participants in the smaller incentive group and 86% (RD = 13; 95% CI, 4.5-21.5) of participants in the larger incentive group were virally suppressed and remained in care. The researchers identified a positive trend among incentive size and viral suppression (P = .0032), but the trend did not significantly differ between either incentive groups (RD = 3.2; 95% CI, –4.6 to 11).
“This study provides an important contribution to understanding the potential of financial incentives to achieve viral suppression in LMICs,” the researchers concluded. “Although further research should investigate the durability of effects from short-term incentives, such as those provided in this study, these findings strengthen the evidence for implementing small financial incentives within standard HIV care as part of a comprehensive strategy for epidemic control.”