How do repeated financial incentives affect HIV care-seeking behaviours over time? Evidence from a cluster-randomised controlled trial

Datos Bibliográficos

ID21881475
AutoresSolis Winters (0000-0002-3269-4495, University of Richmond), Emmanuel Katabaro (Management and Development for Health), Babuu Joseph (Management and Development for Health), Janeth Msasa (Management and Development for Health), Hamza Maila (Management and Development for Health), Kassim Hassan (Management and Development for Health), Amon Sabasaba (0000-0001-9888-8762, Management and Development for Health), William H Dow (0000-0002-4080-1668, School of Public Health, University of California, Berkeley, Berkeley, California, USA), William Dow (Berkeley Public Health Division), Prosper Njau (0000-0002-6351-9489, Ministry of Health and Social Welfare), Prosper F Njau (National AIDS, STIs and Hepatitis Control Programme, Ministry of Health, Dodoma, Tanzania, United Republic of), Sandra I Mccoy (0000-0002-4764-9195, Gilead Sciences (United States))
Año2026
Volumen11
Número2
Páginase022505
Fecha de publicación2026-02-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2025-022505
PMID41702639
OpenAlexW7129495694
IdiomaEN
Referencias citadas28

BACKGROUND: A more nuanced understanding of behavioural responses to incentives over time, particularly after they are removed, could guide more effective interventions. In this study, we build on the primary trial evaluation to explore the dynamic effectiveness of small, short-term monthly financial incentives on HIV care-seeking behaviours during and after incentive removal. METHODS: We conducted a 32-site cluster-randomised controlled trial (NCT04201353) among adult antiretroviral therapy (ART) initiates ( 4 days, 28 days. RESULTS: Among 1990 participants, we found large significant reductions in rate of missed appointments (hazard ratio (HR), 95% CI: 0.51, 0.39 to 0.68), 28 days without ART) (HR, 95% CI: 0.54, 0.35 to 0.83) during the 6 months of incentives, but no effects after their removal. HRs by month reveal similar findings, with dramatic and consistent reductions in risk concentrated in months 2-6 that disappear in month 7, immediately after incentives are discontinued. CONCLUSIONS: These results highlight the value of short-term incentives for initiating new care-seeking behaviours and emphasise a need for innovative design choices, such as escalating rewards or incorporation of time- or context-based cues, that may help motivate sustained behaviour change after their removal. TRIAL REGISTRATION NUMBER: NCT04201353

Incentive · Public health · Randomized controlled trial · Research design · Global Maternal and Child Health · HIV/AIDS Research and Interventions · Poverty, Education, and Child Welfare