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

Abstract

Background: In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. Method: A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. A one-way sensitivity analysis examined the effect of the regimen change to Dolutegravir-based combination (which occurred during the trial) on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria.Result: The ICER of the intervention compared to routine care was US$1,593.2 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold suggested by the World Health Organization (WHO) Commission on Macroeconomics and Health, the intervention was very cost-effective as it costs less than one Nigerian GDP/capita of US$2028.2. The effect of regimen change increased the ICER to US$2,094.38. Healthcare professionals reported that patients’ acceptance of the intervention was very high.Conclusion: The conditional economic incentives and motivational interviewing were very cost-effective. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed.Trial registration This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (https://pactr.samrc.ac.za/: PACTR201806003040425).