“It Makes You Feel Like Someone Cares” acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study

Abstract

BackgroundHPTN 065 (TLC-Plus) evaluated the feasibility and effectiveness of providing quarterly $70 gift card financial incentives to HIV-infected patients on antiretroviral therapy (ART) to encourage ART adherence and viral suppression, and represents the largest study to-date of a financial incentive intervention for HIV viral suppression. A post-trial qualitative substudy was undertaken to examine acceptability of the financial incentives among those receiving and implementing the intervention.MethodsBetween July and October 2013, semi-structured interviews were conducted with 72 patients and 12 investigators from 14 sites; three focus groups were conducted with 12 staff from 10 sites. Qualitative data collection elicited experiences with and attitudes about the intervention, including philosophical viewpoints and implementation experiences. Transcripts were analyzed in NVivo 10. Memos and matrices were developed to explore themes from different participant group perspectives.ResultsPatients, investigators, and staff found the intervention highly acceptable, primarily due to the emotional benefits gained through giving or receiving the incentive. Feeling rewarded or cared for was a main value perceived by patients; this was closely tied to the financial benefit for some. Other factors influencing acceptability for all included perceived effectiveness and health-related benefits, philosophical concerns about the use of incentives for health behavior change, and implementation issues. The termination of the incentive at the end of the study was disappointing to participants and unexpected by some, but generally accepted.ConclusionPositive experiences with the financial incentive intervention and strategies used to facilitate implementation led to high acceptability of the intervention, despite some reluctance in principle to the use of incentives. The findings of this analysis provide encouraging evidence in support of the acceptability of a large-scale financial incentive intervention for HIV viral suppression in a clinical setting, and offer valuable lessons for future applications of similar interventions.

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

“…In some instances, this reduced relational tensions in the home. These findings are consistent with that of Greene and colleagues, where a similar intervention on improving ART adherence among adults allowed patients to use incentives to address their fiscal needs [29]. The high levels of youth engagement in peer-led life skills trainings further demonstrates the acceptability of the program, as 75% of adolescents attended all of the life skills trainings and 96% attended two or more sessions.…”

The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study

“…Qualitative interviews demonstrated that the main value participants with financial incentives perceived was feeling emotionally cared for and rewarded. 29 In addition, HIV transmission is limited to a cohort of partners and does not capture the dynamics of the full sexual network, injection drug use, or motherto-child transmissions. As a result, the model likely underestimates the reduction in HIV transmission by not taking into V A L U E I N H E A L T H 2 2 ( 2 0 1 9 ) 1 9 4 e2 0 2 account the indirect effects of the intervention by preventing future infections, and therefore our analysis provides a conservative estimate of the value of financial incentives.…”

“…27 The main value perceived by patients was feeling rewarded or cared for by their physician. 29 Mathematic models have helped in estimating the effectiveness of HIV prevention 30e33 and assessing the value of an intervention from an economic perspective by projecting long-term outcomes beyond the trial period and estimating the incremental benefits and costs. 34e38 The World Health Organization has shown through modeling that HIV testing and treatment could be used as a strategy for elimination of HIV transmission.…”

Brief Report: Durability of the Effect of Financial Incentives on HIV Viral Load Suppression and Continuity in Care: HPTN 065 Study

“…Reasons for persistence of benefits may be gleaned from qualitative work conducted among staff and patients at sites randomized to FI in HPTN 065. 27,28 In interviews with recipients of FI and staff involved in the intervention at those sites, the incentives were widely welcomed and associated with strong bidirectional emotional benefits, ie, for both the providers and recipients of care. The durability of significant effect of FI on continuity in care demonstrates deeper engagement of patients with their providers and offers an opportunity to garner benefits from ongoing contact with their providers.…”