Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment

Qualitative insights from a randomized trial in Kenya

Bibliographic Data

ID19595073
AuthorsSarah Iguna (0000-0001-9019-6032, Kenya Medical Research Institute, corresponding author), Monica Getahun (0000-0002-2116-2637, University of California, San Francisco), Jayne Lewis-Kulzer (0000-0003-3314-9891, University of California, San Francisco), Gladys Odhiambo (0000-0003-4450-510X, Kenya Medical Research Institute), Harriet Fridah Adhiambo (0000-0002-5323-5474, Kenya Medical Research Institute), Lina Montoya (0000-0002-0975-4306, University of California, Berkeley), Maya L Petersen (0000-0002-5505-153X, University of California, Berkeley), Elizabeth A Bukusi (0000-0002-2031-2808, Kenya Medical Research Institute), Thomas Odeny (0000-0002-1644-2378, University of Missouri–Kansas City), Elvin Geng (0000-0002-0825-1424, Washington University in St. Louis), Carol S Camlin (0000-0001-5615-1164, University of California, San Francisco)
EditorsSangeetha Paramasivan (0000-0001-7329-9574)
Year2022
Volume2
Issue2
Pagese0000204
Publication date2022-02-23
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0000204
PMID36962322
OpenAlexW4212965430
LanguageEN
Citations received3
References cited44

Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways–differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients’ perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: “ I decided to forgo [work] and attend clinic [...] the voucher relieved me ”. Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: “ I borrow with confidence that I will pay after my appointment .” Incentives fostered their autonomy, and enabled them to support others: “ I used the money to buy some clothes and Pampers for the children .” Participants who were intrinsically motivated to engage in care (“ my life depends on the drugs , not the incentive ”), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention

Autonomy · Business · Economics · Feeling · Incentive · Political science · Qualitative research · Randomized controlled trial · Sociology · Voucher · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Medicine · Nursing · Poverty, Education, and Child Welfare · Psychology · Social Psychology