A Commitment Device for Medication Adherence Among HIV Patients

National Bureau of Economic Research, Inc.

Status: Completed

Conditions: HIV; Acquired Immunodeficiency Syndrome

Treatments: Behavioral: Provider Visit Incentive (PVI); Behavioral: Incentive Choice (IC)

Study type: Interventional

Funder types: Other

Identifiers

NCT01455740

0005

Details and patient eligibility

About

We used a randomized trial design combined with a comparison to a non-randomized control group to study patients on appropriate antiretroviral therapy (ART) having virologic failure within a publicly-funded HIV clinic serving Atlanta, GA.

Full description

This study demonstrated the feasibility of using commitment contracts in HIV care. Many previous interventions have produced statistically significant effects on ART adherence that do not persist after the intervention ends. A notable feature of our study is that after the incentives for ART adherence and provider visits were removed, participants who had been offered a commitment contract for ART adherence were more likely to achieve virologic suppression relative to individuals who had been assigned a conditional cash transfer for provider visits and relative to individuals who had been assigned the standard of care, although the difference was only statistically significant in the latter comparison. There were differences in the prevalence of missing outcomes across groups, but these differences were not statistically significant for the unanticipated post-incentive visit and therefore were unlikely to be the explanation for the results. Thus, financial rewards coupled with individual choice can increase engagement in healthy behaviors after incentives are removed.

Enrollment: 110 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Attended the Grady Health System Infectious Disease Program (IDP)
• Most recent HIV-1 plasma RNA viral load (pVL) > 200 copies/mL; this value must have been measured within the prior 18 months and at least 6 months after starting the current ART regimen
• English-speaking

Exclusion criteria

• Using pillboxes
• Were planning to relocate
• Were enrolled in another trial

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

110 participants in 3 patient groups

Provider Visit Incentive (PVI)

Experimental group

Description:

Participants were told that they would receive $30 after attending each scheduled provider visit (a CCT). A block randomization scheme, stratified on whether or not the majority of the participant's three previous viral load measurements were suppressed, assigned 21 individuals to the PVI arm.

Treatment:

Behavioral: Provider Visit Incentive (PVI)

Incentive Choice (IC)

Experimental group

Description:

Participants were given a choice between the CCT described in the PVI arm and a commitment contract, which made the $30 payment conditional on the patient attending the provider visit AND meeting an ART adherence threshold. A block randomization scheme, stratified on whether or not the majority of the participant's three previous viral load measurements were suppressed, assigned 19 individuals to the IC arm.

Treatment:

Behavioral: Incentive Choice (IC)

Passive Control (PC)

No Intervention group

Description:

The study also included 70 individuals in a PC arm, who did not receive financial incentives. Individuals in the PC arm were not enrolled in the randomized trial but met basic study eligibility criteria during the same time period.