Conditional economic incentives and motivational interviewing to improve adolescents’ retention in HIV care and adherence to antiretroviral therapy in Southeast Nigeria: study protocol for a cluster randomised trial

Abstract

BackgroundAdolescent HIV patients face enormous difficulty in accessing HIV care services. Given their vulnerability to risk-taking behaviour, this group also have worse treatment outcomes compared to other age groups. Poor treatment outcomes will impact negatively on HIV/AIDS management and control particularly in sub-Saharan Africa (SSA) as more than eight out of ten of the world’s HIV-infected adolescents live in this region of the world. Limited evidence exists on the effectiveness of service delivery interventions to support adolescents’ retention on antiretroviral therapy (ART) and adherence to ART. This trial is designed to evaluate the impact of conditional economic incentive and motivational interviewing on adolescents’ retention in HIV care and adherence to ART in Anambra State, Southeast Nigeria.Methods/designThe study will be a cluster randomised controlled trial that will be conducted in selected HIV treatment hospitals in Anambra State, Nigeria. Based on sample size calculation, 12 HIV treatment hospitals from Anambra will be selected for the study. Six HIV treatment hospitals each will be randomised to either the intervention or the control arm. A structured adherence support scheme termed the ‘Incentive Scheme’ will be applied to the intervention arm while the control arm will receive routine HIV care (usual care). Additionally, patients in the intervention arm will receive motivational interviewing at baseline and following initiation of antiretroviral therapy (ART), they will receive a gift voucher of US$5.6 when HIV viral load (VL) is < 20 copies/mL at 12 weeks, a gift voucher of US$2.8 if the VL remains suppressed for the next 3 months, and the next 6 months, and finally a gift voucher of US$5.6 if the VL remains < 20 copies/mL at 1 year. All gift vouchers will be conditional not only on VL results but attending the motivational interviews. The primary outcome for the trial will be the difference between groups in the proportion with HIV VL suppression (≤ 20 copies/mL) by 12 months and then 24 months after withdrawal of incentive.DiscussionThe findings of this proposed trial will provide evidence on the feasibility of applying conditional economic incentives combined with motivational interviewing to improve retention and adherence to antiretroviral therapy of adolescents living with HIV in Nigeria and possibly in other sub-Saharan African countries.Trial registrationRegistered in the Pan African Clinical Trials Registry, ID: PACTR201806003040425. Registered on 2 February 2018.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-3095-4) contains supplementary material, which is available to authorized users.

Interventions to Improve Antiretroviral Therapy Adherence Among Adolescents and Youth in Low- and Middle-Income Countries: A Systematic Review 2015–2019

“…The increase in the number and location of studies observed compared to the earlier review indicates a positive shift of focus to identify interventions to improve outcomes in regions with the greatest HIV burden. Additional high-quality evidence should be emerging soon from four ongoing RCTs we identified, two from sub-Saharan Africa [62][63][64][65].…”

Cost-effectiveness and Feasibility of Conditional Economic Incentives and Motivational Interviewing to Improve HIV Health Outcomes of Adolescents Living with HIV in Anambra State, Nigeria

“…This cash reward was linked to attaining undetected viral load and also attending motivational interview sessions on each clinic visit. Further information on the methods can be found on the trial protocol [6], while the completed trial is currently under peer review for publication (unpublished data).…”

“…Poor retention-in-care and adherence to ART in adolescents may be connected to the unique psychological, social and health needs that are peculiar to the adolescent stage [6]. These coupled with lack of interventions channelled to the care of adolescents [2] have led to a 30% increase in new HIV infections among adolescents and youth (15-24 years) as well as increased HIV-related mortality and morbidity in adolescents with HIV unlike in other age groups [3], making HIV the second leading cause of death among adolescents globally [6].…”

“…The combination of conditional economic incentives (CEI) and motivational interviewing are theoretically promising interventions to improve HIV health outcomes in adolescents. While CEI produces an immediate improvement, motivational interviewing brings about long-lasting change as good behaviour is internalized [6]. However, in a resource-limited setting, it is important to determine whether allocating resources to these interventions would yield good value for money.…”

Feasibility and acceptability of financial incentives and peer-led life skills training for improving adherence to antiretroviral therapy among adolescents living with HIV in Rwanda: A pilot study

“…Researchers in South Africa demonstrated that access to cash through social protection schemes mitigated risk-taking behavior among adolescents [21]. In Nigeria, cash transfers that incentivized adolescent girls to remain in school reduced risky behavior and HIV acquisition [22].…”