Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya

• DOI: 10.1371/journal.pgph.0000204
• Publication Date: 2022-02-23T18:31:13Z
• Authors: Sarah Iguna; Monica Getahun; Jayne Lewis-Kulzer; Gladys Odhiambo; Fridah Adhiambo; Lina Montoya; Maya L. Petersen; Elizabeth Bukusi; Thomas Odeny; Elvin Geng; Carol S. Camlin
• Keywords: Voucher

Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why impact various patients in different ways-differences that may be due to variations psychological and social mechanisms effect. A deeper understanding patients' perceptions experiences CCIs for retention help clarify these mechanisms. We conducted a qualitative study embedded the ADAPT-R trial (NCT#02338739), sequential multiple assignment randomized (SMART) evaluated economic support among persons living with (PLHIV) initiating antiretroviral therapy Kenya. Participants who attended their scheduled clinic visits received an incentive approximately $4 each visit. Interviews were between July 2016 June 2017 39 participants explore attitudes engagement. Analyses revealed helped PLHIV prioritize care-seeking by alleviating transport barriers food insecurity: "I decided forgo [work] attend […] voucher relieved me". Patients borrowed money reported feeling from burden indebtedness others: borrow confidence I will pay after my appointment." Incentives fostered autonomy, enabled them used buy some clothes Pampers children." intrinsically motivated engage ("my life depends drugs, not incentive"), those mistrusted researchers, being less prompted itself. For already prioritizing care-seeking, facilitated engagement through costs, insecurity, also supported role fulfillment. Conditional important cue action improve progression treatment cascade, contribute better