Past study supports the use of direct monetary incentives to improve retention in HIV care and antiretroviral therapy (ART) adherence. But few assessments have examined the impact of such policies on biological outcomes, and few have compared the impact of different incentive amounts.

Investigators in Tanzania trialed modest, automated financial incentives for clinic attendance on viral suppression for patients initiating ART. Findings were presented at the International AIDS Society (IAS) AIDS 2020 Virtual Sessions.

The study design included a 3-arm parallel-group randomized control process. At 4 clinics in the Shinyanga region, investigators recruited adults living with HIV who initiated ART fewer than 30 days prior in order to assess how viral load outcomes might vary between the 3 groups at the end of the trial period.

Between April-December 2018, 530 participants were allocated (1:1:1) to the control group or to receive a monthly cash incentive, conditional on clinic attendance, of either 10,000 TZS ('US $4.50) or 22,500 TZS ('US $10.00).

There were 184 patients in the control group, 174 in the larger incentive group, and 172 in the smaller incentive group.

Monetary transfers were delivered for up to 6 months via mobile health technology which monitored attendance and disbursed payments autonomously. The team then evaluated the relationship between incentive size and viral suppression (<1000 copies/ml) at 6 months using logistic regression.

By 6 months, about 73.0% of participants in the control group remained on ART and achieved viral suppression, compared to 82.9% in the smaller incentive group [risk difference (RD)=9.9, 95% CI: 1.2'18.5] and 86.1% in the larger incentive group (RD=13.1, 95% CI: 4.5'21.5)

Testing trends showed a positive relationship between increasing incentive size and viral suppression (OR=1.10 per 2500 TZS, 95% CI: 1.03 to 1.17, p-trend=0.003), although the pairwise comparisons suggest a threshold effect.

Improvements were seen among all pre-specified secondary outcomes, such as retention on ART and appointment attendance.

“Small, automated financial incentives improved retention in care and viral suppression among adults starting ART in Tanzania. These findings strengthen the evidence for implementing incentives within standard HIV care,” the presentation authors concluded.

Related AIDS 2020 Coverage:

In Developing World, Pharmacies Can Play Important Role for HIV Patients

UNAIDS Report: Inequality and Coronavirus Risk a Decade of HIV Progress