TY - JOUR
T1 - Behavioral Economics Incentives to Support HIV Treatment Adherence (BEST)
T2 - Protocol for a randomized controlled trial in Uganda
AU - Linnemayr, Sebastian
AU - Stecher, Chad
AU - Saya, Uzaib
AU - MacCarthy, Sarah
AU - Wagner, Zachary
AU - Jennings, Larissa
AU - Mukasa, Barbara
N1 - Funding Information:
This trial is funded by the National Institute of Mental Health in the US (R01, MH110350–01, principal investigator SL). The funder played no role in the study design; collection, management, analysis, or interpretation of data; writing of the report; or the decision to submit the report for publication.
Publisher Copyright:
© 2020 The Author(s).
PY - 2020/1/3
Y1 - 2020/1/3
N2 - Background: Many HIV-positive patients do not appropriately adhere to their antiretroviral medication (ART). This leads to higher viral loads and greater probability of HIV transmission. Present bias-a tendency to give in to short-term temptations at the expense of long-term outcomes-is a potential driver of low adherence. In this study we test a novel intervention rooted in behavioral economics that is designed to overcome present bias and increase ART adherence. Methods/design: We will enroll 330 HIV-positive patients at Mildmay Hospital in Kampala, Uganda, into a 2-year randomized controlled trial. Participants will be randomized to one of three groups. The first intervention group (T1, n = 110) will be eligible for small lottery prizes based on timely clinic visits and demonstration of viral suppression. Group 2 (T2, n = 110) will be eligible for the same lottery prizes conditional on high adherence measured by a medication event management system (MEMS) cap. The control group (n = 110) will receive the usual standard of care. Adherence will be measured continuously throughout the intervention period and for 12 months post-intervention to evaluate effect persistence. Surveys will be conducted at baseline and then every 6 months. Viral loads will be measured annually. Primary outcomes are whether the viral load is detectable and MEMS-measured adherence. Secondary outcomes are the log-transformed viral load as a continuous measure and a binary measure for whether the person took at least 90% of their ART pills. Discussion: Our study is one of the first to investigate the effectiveness of lottery incentives for improving ART adherence, and in addition, it compares the relative efficacy of using electronically measured adherence versus viral load to determine lottery eligibility. MEMS caps are relatively costly, whereas viral load testing is now part of routine clinical care in Uganda. BEST will test whether directly incentivizing viral suppression (which can be implemented using readily available clinic data) is as effective as incentivizing electronically measured adherence. Cost-effectiveness analyses of the two implementation modes will also be performed. Trial registration: ClinicalTrials.gov, NCT03494777. Registered on 11 April 2018.
AB - Background: Many HIV-positive patients do not appropriately adhere to their antiretroviral medication (ART). This leads to higher viral loads and greater probability of HIV transmission. Present bias-a tendency to give in to short-term temptations at the expense of long-term outcomes-is a potential driver of low adherence. In this study we test a novel intervention rooted in behavioral economics that is designed to overcome present bias and increase ART adherence. Methods/design: We will enroll 330 HIV-positive patients at Mildmay Hospital in Kampala, Uganda, into a 2-year randomized controlled trial. Participants will be randomized to one of three groups. The first intervention group (T1, n = 110) will be eligible for small lottery prizes based on timely clinic visits and demonstration of viral suppression. Group 2 (T2, n = 110) will be eligible for the same lottery prizes conditional on high adherence measured by a medication event management system (MEMS) cap. The control group (n = 110) will receive the usual standard of care. Adherence will be measured continuously throughout the intervention period and for 12 months post-intervention to evaluate effect persistence. Surveys will be conducted at baseline and then every 6 months. Viral loads will be measured annually. Primary outcomes are whether the viral load is detectable and MEMS-measured adherence. Secondary outcomes are the log-transformed viral load as a continuous measure and a binary measure for whether the person took at least 90% of their ART pills. Discussion: Our study is one of the first to investigate the effectiveness of lottery incentives for improving ART adherence, and in addition, it compares the relative efficacy of using electronically measured adherence versus viral load to determine lottery eligibility. MEMS caps are relatively costly, whereas viral load testing is now part of routine clinical care in Uganda. BEST will test whether directly incentivizing viral suppression (which can be implemented using readily available clinic data) is as effective as incentivizing electronically measured adherence. Cost-effectiveness analyses of the two implementation modes will also be performed. Trial registration: ClinicalTrials.gov, NCT03494777. Registered on 11 April 2018.
KW - Behavioral Economics
KW - Global Health
KW - HIV/AIDS
KW - Incentives
KW - Lottery
KW - Present Bias
KW - Randomized Controlled Trial
KW - Uganda
UR - http://www.scopus.com/inward/record.url?scp=85077479844&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85077479844&partnerID=8YFLogxK
U2 - 10.1186/s13063-019-3795-4
DO - 10.1186/s13063-019-3795-4
M3 - Article
C2 - 31900193
AN - SCOPUS:85077479844
VL - 21
JO - Trials
JF - Trials
SN - 1745-6215
IS - 1
M1 - 9
ER -
