It Helps Me Live, Sends My Children to School, and Feeds Me: a Qualitative Study of How Food and Cash Incentives May Improve Adherence to Treatment and Care Among Adults Living with HIV in Tanzania

Overview

Journal AIDS Care

Publisher Informa Healthcare

Specialty Infectious Diseases

Date 2017 Apr 12

PMID 28397527

Citations 23

Authors

Nancy L Czaicki

Agatha Mnyippembe

Madeline Blodgett

Prosper Njau

Sandra I McCoy

Affiliations

Soon will be listed here.

Abstract

Financial and in-kind incentives have been shown to improve outcomes along the HIV care cascade, however the potential mechanismsthrough which they work remain unclear. To identify the pathways through which incentives improve retention in care and adherence to antiretroviral therapy (ART), we conducted a qualitative study with participants in a trial evaluating conditional food and cash incentives for HIV-positive food insecure adults in Shinyanga, Tanzania. We found that the incentives acted through three pathways to potentially increase retention in care and adherence to ART: (1) addressing competing needs and offsetting opportunity costs associated with clinic attendance, (2) alleviating stress associated with attending clinic and meeting basic needs, and (3) by potentially increasing motivation. Participants did not report any harmful events associated with the incentives, but reported myriad beneficial effects on household welfare. Understanding how incentives are used and how they impact outcomes can improve the design of future interventions.

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References

McCoy S, Shiu K, Martz T, Smith C, Mattox L, Gluth D . Improving the efficiency of HIV testing with peer recruitment, financial incentives, and the involvement of persons living with HIV infection. J Acquir Immune Defic Syndr. 2013; 63(2):e56-63. DOI: 10.1097/QAI.0b013e31828a7629. View

Haukoos J, Witt M, Coil C, Lewis R . The effect of financial incentives on adherence with outpatient human immunodeficiency virus testing referrals from the emergency department. Acad Emerg Med. 2005; 12(7):617-21. DOI: 10.1197/j.aem.2005.02.016. View

McCoy S, Njau P, Czaicki N, Kadiyala S, Jewell N, Dow W . Rationale and design of a randomized study of short-term food and cash assistance to improve adherence to antiretroviral therapy among food insecure HIV-infected adults in Tanzania. BMC Infect Dis. 2015; 15:490. PMC: 4628274. DOI: 10.1186/s12879-015-1186-3. View

Huynh A, Kinsler J, Cunningham W, Sayles J . The role of mental health in mediating the relationship between social support and optimal ART adherence. AIDS Care. 2013; 25(9):1179-84. PMC: 3633692. DOI: 10.1080/09540121.2012.752787. View

Kilburn K, Thirumurthy H, Halpern C, Pettifor A, Handa S . Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. J Adolesc Health. 2015; 58(2):223-9. PMC: 4724529. DOI: 10.1016/j.jadohealth.2015.09.023. View

de Walque D, Dow W, Nathan R, Abdul R, Abilahi F, Gong E . Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ Open. 2012; 2:e000747. PMC: 3330254. DOI: 10.1136/bmjopen-2011-000747. View

Ozer E, Fernald L, Weber A, Flynn E, VanderWeele T . Does alleviating poverty affect mothers' depressive symptoms? A quasi-experimental investigation of Mexico's Oportunidades programme. Int J Epidemiol. 2011; 40(6):1565-76. PMC: 3235019. DOI: 10.1093/ije/dyr103. View

Loewenstein G, Brennan T, Volpp K . Asymmetric paternalism to improve health behaviors. JAMA. 2007; 298(20):2415-7. DOI: 10.1001/jama.298.20.2415. View

Thornton R . The Demand for, and Impact of, Learning HIV Status. Am Econ Rev. 2011; 98(5):1829-1863. PMC: 3115776. DOI: 10.1257/aer.98.5.1829. View

10.

Safren S, Mayer K, Ou S, McCauley M, Grinsztejn B, Hosseinipour M . Adherence to Early Antiretroviral Therapy: Results From HPTN 052, a Phase III, Multinational Randomized Trial of ART to Prevent HIV-1 Sexual Transmission in Serodiscordant Couples. J Acquir Immune Defic Syndr. 2015; 69(2):234-40. PMC: 4445420. DOI: 10.1097/QAI.0000000000000593. View

11.

Baird S, Garfein R, McIntosh C, Ozler B . Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial. Lancet. 2012; 379(9823):1320-9. DOI: 10.1016/S0140-6736(11)61709-1. View

12.

Wouters E, Meulemans H, van Rensburg H, Heunis J, Mortelmans D . Short-term physical and emotional health outcomes of public sector ART in the Free State province of South Africa. Qual Life Res. 2007; 16(9):1461-71. DOI: 10.1007/s11136-007-9260-y. View

13.

Anuradha S, Joshi A, Negi M, Nischal N, Rajeshwari K, Dewan R . Factors influencing adherence to ART: new insights from a center providing free ART under the national program in Delhi, India. J Int Assoc Provid AIDS Care. 2012; 12(3):195-201. DOI: 10.1177/1545109711431344. View

14.

Pettifor A, MacPhail C, Nguyen N, Rosenberg M . Can money prevent the spread of HIV? A review of cash payments for HIV prevention. AIDS Behav. 2012; 16(7):1729-38. PMC: 3608680. DOI: 10.1007/s10461-012-0240-z. View

15.

McCoy S, Njau P, Fahey C, Kapologwe N, Kadiyala S, Jewell N . Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania. AIDS. 2017; 31(6):815-825. PMC: 5342932. DOI: 10.1097/QAD.0000000000001406. View

16.

Weiser S, Young S, Cohen C, Kushel M, Tsai A, Tien P . Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011; 94(6):1729S-1739S. PMC: 3226026. DOI: 10.3945/ajcn.111.012070. View

17.

Heise L, Lutz B, Ranganathan M, Watts C . Cash transfers for HIV prevention: considering their potential. J Int AIDS Soc. 2013; 16:18615. PMC: 3752431. DOI: 10.7448/IAS.16.1.18615. View

18.

Galarraga O, Genberg B, Martin R, Laws M, Wilson I . Conditional economic incentives to improve HIV treatment adherence: literature review and theoretical considerations. AIDS Behav. 2013; 17(7):2283-92. PMC: 3688660. DOI: 10.1007/s10461-013-0415-2. View

19.

Adato M, Roopnaraine T, Becker E . Understanding use of health services in conditional cash transfer programs: insights from qualitative research in Latin America and Turkey. Soc Sci Med. 2010; 72(12):1921-9. DOI: 10.1016/j.socscimed.2010.09.032. View

20.

Starace F, Ammassari A, Trotta M, Murri R, De Longis P, Izzo C . Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2003; 31 Suppl 3:S136-9. DOI: 10.1097/00126334-200212153-00010. View