A Commitment Device for Medication Adherence Among HIV Patients
| Status: | Completed |
|---|---|
| Conditions: | HIV / AIDS, HIV / AIDS, HIV / AIDS |
| Therapuetic Areas: | Immunology / Infectious Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/20/2017 |
| Start Date: | October 2011 |
| End Date: | October 2014 |
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.
group to study patients on appropriate antiretroviral therapy (ART) having virologic failure
within a publicly-funded HIV clinic serving Atlanta, GA.
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.
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.
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
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