HIV patients who lose short-term financial incentives to receive care don’t fare worse after payments cease

Despite the breakthroughs in HIV prevention, there are still about 39 million people around the world living with the disease. Many of these individuals can live long, productive lives, as long as they remain in treatment. But in many parts of the world HIV-positive people face tough barriers to medical care.

Sandra McCoy, professor of epidemiology at UC Berkeley School of Berkeley Public Health, studies how small, short-term incentives like money or gifts can be used to nudge people to remain in HIV care.

In a study published August 1 in Lancet HIV, McCoy’s team answered a longstanding question about short-term financial incentives: Once the money stops, are patients less likely to continue medical care than they would have been had they never received incentives at all?

“It’s well known that people respond to incentives,” McCoy said. “But there was a theory that when you take them away people do worse—because they no longer have that carrot that’s motivating them. We’ve demonstrated that does not happen.”

An international research team studied 1,990 people living with HIV in Tanzania, who began antiretroviral therapy (ART) between May 2021 and March 2022. In a type 1 hybrid effectiveness-implementation study, researchers randomized 32 primary care HIV clinics in four regions to a comparison group getting the usual care, and the intervention group, which received the usual care plus monthly incentives of the equivalent of about ten U.S. dollars.

“A major strength of our study was that we followed people for six months after incentives were removed,” explained Solis Winters, PhD Candidate in Health Policy and Management and project coordinator. “At the end of the follow-up period, we found no differences in retention in care or HIV viral suppression between the group that received incentives and the group receiving usual care. We conclude that, in this setting, there are no negative consequences of providing incentives in the long term.”

“One of the main takeaways of this study is to put to rest the assertion that even if financial incentives are beneficial while they are in place, they will harm people later on. We see no evidence of that,” McCoy said. “This means that we can feel more confident implementing programs in this setting that include small nudges to help people engage with new health services and products.”