Understanding the role of incentives for achieving and sustaining viral suppression: A qualitative sub-study of a financial incentives trial in Uganda
Background Viral suppression among people living with HIV (PLHIV) is essential for protecting health and preventing HIV transmission, yet globally, rates of viral suppression are sub-optimal. Interventions to improve HIV prevention and care cascade outcomes remain vital. Financial incentives hold pr...
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| Veröffentlicht in: | PloS one 2022-06, Vol.17 (6), p.e0270180-e0270180 |
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| creator | Camlin, Carol S Marson, Kara Ndyabakira, Alex Getahun, Monica Emperador, Devy Byamukama, Ambrose Kwarisiima, Dalsone Thirumurthy, Harsha Chamie, Gabriel |
| description | Background Viral suppression among people living with HIV (PLHIV) is essential for protecting health and preventing HIV transmission, yet globally, rates of viral suppression are sub-optimal. Interventions to improve HIV prevention and care cascade outcomes remain vital. Financial incentives hold promise for improving these outcomes, yet to date, clinical trial results have been mixed. Methods This qualitative sub-study, embedded in a trial (NCT02890459) in Uganda to test whether incentives are effective for achieving viral suppression in PLHIV, sought to enhance our understanding of the factors that influence this outcome. Forty-nine (n = 49) PLHIV, purposely sampled to balance across gender, study arm, and viral suppression status, were interviewed to explore barriers and motivations for care engagement, adherence, and viral suppression, and attributions for decision-making, including perceived influence of incentives on behaviors. Results While many participants with undetectable viral load (VL) who received incentives said the incentives motivated their ART adherence, others expressed intrinsic motivation for adherence. All felt that incentives reduced burdens of transport costs, lost income due to time spent away from work, and food insecurity. Incentives may have activated attention and memory for some, as excitement about anticipating incentives helped them adhere to medication schedules. In comparison, participants who were randomized to receive incentives but had detectable VL faced a wider range, complexity and severity of challenges to care engagement. Notably, their narratives included more accounts of poor treatment in clinics, food insecurity, and severe forms of stigma. With or without incentives, adherence was reinforced through experiencing restored health due to ART, social support (especially from partners), and good quality counseling and clinical care. Conclusions In considering why incentives sometimes fail to achieve behavior change, it may be helpful to attend to the full set of factors- psychological, interpersonal, social and structural- that militate against the behavior change required to achieve behavioral outcomes. To be effective, incentives may need to be combined with other interventions to address the spectrum of barriers to care engagement. |
| doi_str_mv | 10.1371/journal.pone.0270180 |
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Interventions to improve HIV prevention and care cascade outcomes remain vital. Financial incentives hold promise for improving these outcomes, yet to date, clinical trial results have been mixed. Methods This qualitative sub-study, embedded in a trial (NCT02890459) in Uganda to test whether incentives are effective for achieving viral suppression in PLHIV, sought to enhance our understanding of the factors that influence this outcome. Forty-nine (n = 49) PLHIV, purposely sampled to balance across gender, study arm, and viral suppression status, were interviewed to explore barriers and motivations for care engagement, adherence, and viral suppression, and attributions for decision-making, including perceived influence of incentives on behaviors. Results While many participants with undetectable viral load (VL) who received incentives said the incentives motivated their ART adherence, others expressed intrinsic motivation for adherence. All felt that incentives reduced burdens of transport costs, lost income due to time spent away from work, and food insecurity. Incentives may have activated attention and memory for some, as excitement about anticipating incentives helped them adhere to medication schedules. In comparison, participants who were randomized to receive incentives but had detectable VL faced a wider range, complexity and severity of challenges to care engagement. Notably, their narratives included more accounts of poor treatment in clinics, food insecurity, and severe forms of stigma. With or without incentives, adherence was reinforced through experiencing restored health due to ART, social support (especially from partners), and good quality counseling and clinical care. Conclusions In considering why incentives sometimes fail to achieve behavior change, it may be helpful to attend to the full set of factors- psychological, interpersonal, social and structural- that militate against the behavior change required to achieve behavioral outcomes. To be effective, incentives may need to be combined with other interventions to address the spectrum of barriers to care engagement.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0270180</identifier><identifier>PMID: 35749510</identifier><language>eng</language><publisher>San Francisco: Public Library of Science</publisher><subject>Age ; Antiretroviral therapy ; Biology and Life Sciences ; Data collection ; Decision making ; Disease transmission ; Drug therapy ; Economic incentives ; Evaluation ; Food security ; Gender ; Health aspects ; HIV ; Human immunodeficiency virus ; Incentives ; Intervention ; Interviews ; Medical tests ; Medicine and Health Sciences ; Monetary incentives ; Motivation ; Pediatrics ; Prevention ; Sexually transmitted diseases ; Social interactions ; Social Sciences ; Success ; Womens health</subject><ispartof>PloS one, 2022-06, Vol.17 (6), p.e0270180-e0270180</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Camlin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Camlin et al 2022 Camlin et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c669t-cc27f68062a71f860d01c6cccd8f83d36fc64beda78273fb7c03390edc0666b43</citedby><cites>FETCH-LOGICAL-c669t-cc27f68062a71f860d01c6cccd8f83d36fc64beda78273fb7c03390edc0666b43</cites><orcidid>0000-0001-5615-1164</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231797/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231797/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23864,27922,27923,53789,53791,79370,79371</link.rule.ids></links><search><contributor>Ekwunife, Obinna Ikechukwu</contributor><creatorcontrib>Camlin, Carol S</creatorcontrib><creatorcontrib>Marson, Kara</creatorcontrib><creatorcontrib>Ndyabakira, Alex</creatorcontrib><creatorcontrib>Getahun, Monica</creatorcontrib><creatorcontrib>Emperador, Devy</creatorcontrib><creatorcontrib>Byamukama, Ambrose</creatorcontrib><creatorcontrib>Kwarisiima, Dalsone</creatorcontrib><creatorcontrib>Thirumurthy, Harsha</creatorcontrib><creatorcontrib>Chamie, Gabriel</creatorcontrib><title>Understanding the role of incentives for achieving and sustaining viral suppression: A qualitative sub-study of a financial incentives trial in Uganda</title><title>PloS one</title><description>Background Viral suppression among people living with HIV (PLHIV) is essential for protecting health and preventing HIV transmission, yet globally, rates of viral suppression are sub-optimal. Interventions to improve HIV prevention and care cascade outcomes remain vital. Financial incentives hold promise for improving these outcomes, yet to date, clinical trial results have been mixed. Methods This qualitative sub-study, embedded in a trial (NCT02890459) in Uganda to test whether incentives are effective for achieving viral suppression in PLHIV, sought to enhance our understanding of the factors that influence this outcome. Forty-nine (n = 49) PLHIV, purposely sampled to balance across gender, study arm, and viral suppression status, were interviewed to explore barriers and motivations for care engagement, adherence, and viral suppression, and attributions for decision-making, including perceived influence of incentives on behaviors. Results While many participants with undetectable viral load (VL) who received incentives said the incentives motivated their ART adherence, others expressed intrinsic motivation for adherence. All felt that incentives reduced burdens of transport costs, lost income due to time spent away from work, and food insecurity. Incentives may have activated attention and memory for some, as excitement about anticipating incentives helped them adhere to medication schedules. In comparison, participants who were randomized to receive incentives but had detectable VL faced a wider range, complexity and severity of challenges to care engagement. Notably, their narratives included more accounts of poor treatment in clinics, food insecurity, and severe forms of stigma. With or without incentives, adherence was reinforced through experiencing restored health due to ART, social support (especially from partners), and good quality counseling and clinical care. Conclusions In considering why incentives sometimes fail to achieve behavior change, it may be helpful to attend to the full set of factors- psychological, interpersonal, social and structural- that militate against the behavior change required to achieve behavioral outcomes. To be effective, incentives may need to be combined with other interventions to address the spectrum of barriers to care engagement.</description><subject>Age</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Data collection</subject><subject>Decision making</subject><subject>Disease transmission</subject><subject>Drug therapy</subject><subject>Economic incentives</subject><subject>Evaluation</subject><subject>Food security</subject><subject>Gender</subject><subject>Health aspects</subject><subject>HIV</subject><subject>Human immunodeficiency virus</subject><subject>Incentives</subject><subject>Intervention</subject><subject>Interviews</subject><subject>Medical tests</subject><subject>Medicine and Health Sciences</subject><subject>Monetary incentives</subject><subject>Motivation</subject><subject>Pediatrics</subject><subject>Prevention</subject><subject>Sexually transmitted diseases</subject><subject>Social 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the role of incentives for achieving and sustaining viral suppression: A qualitative sub-study of a financial incentives trial in Uganda</title><author>Camlin, Carol S ; Marson, Kara ; Ndyabakira, Alex ; Getahun, Monica ; Emperador, Devy ; Byamukama, Ambrose ; Kwarisiima, Dalsone ; Thirumurthy, Harsha ; Chamie, Gabriel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c669t-cc27f68062a71f860d01c6cccd8f83d36fc64beda78273fb7c03390edc0666b43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Antiretroviral therapy</topic><topic>Biology and Life Sciences</topic><topic>Data collection</topic><topic>Decision making</topic><topic>Disease transmission</topic><topic>Drug therapy</topic><topic>Economic incentives</topic><topic>Evaluation</topic><topic>Food security</topic><topic>Gender</topic><topic>Health aspects</topic><topic>HIV</topic><topic>Human immunodeficiency 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trial in Uganda</atitle><jtitle>PloS one</jtitle><date>2022-06-24</date><risdate>2022</risdate><volume>17</volume><issue>6</issue><spage>e0270180</spage><epage>e0270180</epage><pages>e0270180-e0270180</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Background Viral suppression among people living with HIV (PLHIV) is essential for protecting health and preventing HIV transmission, yet globally, rates of viral suppression are sub-optimal. Interventions to improve HIV prevention and care cascade outcomes remain vital. Financial incentives hold promise for improving these outcomes, yet to date, clinical trial results have been mixed. Methods This qualitative sub-study, embedded in a trial (NCT02890459) in Uganda to test whether incentives are effective for achieving viral suppression in PLHIV, sought to enhance our understanding of the factors that influence this outcome. Forty-nine (n = 49) PLHIV, purposely sampled to balance across gender, study arm, and viral suppression status, were interviewed to explore barriers and motivations for care engagement, adherence, and viral suppression, and attributions for decision-making, including perceived influence of incentives on behaviors. Results While many participants with undetectable viral load (VL) who received incentives said the incentives motivated their ART adherence, others expressed intrinsic motivation for adherence. All felt that incentives reduced burdens of transport costs, lost income due to time spent away from work, and food insecurity. Incentives may have activated attention and memory for some, as excitement about anticipating incentives helped them adhere to medication schedules. In comparison, participants who were randomized to receive incentives but had detectable VL faced a wider range, complexity and severity of challenges to care engagement. Notably, their narratives included more accounts of poor treatment in clinics, food insecurity, and severe forms of stigma. With or without incentives, adherence was reinforced through experiencing restored health due to ART, social support (especially from partners), and good quality counseling and clinical care. Conclusions In considering why incentives sometimes fail to achieve behavior change, it may be helpful to attend to the full set of factors- psychological, interpersonal, social and structural- that militate against the behavior change required to achieve behavioral outcomes. To be effective, incentives may need to be combined with other interventions to address the spectrum of barriers to care engagement.</abstract><cop>San Francisco</cop><pub>Public Library of Science</pub><pmid>35749510</pmid><doi>10.1371/journal.pone.0270180</doi><tpages>e0270180</tpages><orcidid>https://orcid.org/0000-0001-5615-1164</orcidid><oa>free_for_read</oa></addata></record> |
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| source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Age Antiretroviral therapy Biology and Life Sciences Data collection Decision making Disease transmission Drug therapy Economic incentives Evaluation Food security Gender Health aspects HIV Human immunodeficiency virus Incentives Intervention Interviews Medical tests Medicine and Health Sciences Monetary incentives Motivation Pediatrics Prevention Sexually transmitted diseases Social interactions Social Sciences Success Womens health |
| title | Understanding the role of incentives for achieving and sustaining viral suppression: A qualitative sub-study of a financial incentives trial in Uganda |
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