Effects of financial incentives for clinic attendance on economic well-being among adults initiating antiretroviral therapy in Tanzania: a three-arm randomized controlled trial

Title

Effects of financial incentives for clinic attendance on economic well-being among adults initiating antiretroviral therapy in Tanzania: a three-arm randomized controlled trial

Presenter

Carolyn Fahey

Authors

C. Fahey * (1,2), P. Njau (3), E. Katabaro (4), Y. Ndungile (5), S. McCoy (2)

Institutions

(1) University of Washington, Seattle, United States, (2) University of California, Berkeley, United States, (3) Ministry of Health, Community Development, Gender Elderly and Children (MOHCDGEC), Dodoma, Tanzania, The United Republic of, (4) Health for a Prosperous Nation, Shinyanga, Tanzania, The United Republic of, (5) Ministry of Health, Community Development, Gender Elderly and Children (MOHCDGEC), Shinyanga, Tanzania, The United Republic of

BACKGROUND: Financial incentives for clinic attendance are shown to promote retention in HIV care and antiretroviral therapy (ART) adherence. However, few randomized studies have assessed potential secondary impacts of these incentives on economic well-being. We examined the effects of different incentive sizes on employment, food insecurity, and wealth among adults ('¥18 years) starting ART ('¤30 days) in Tanzania.
METHODS: We conducted a three-arm parallel-group randomized controlled trial at four clinics in Shinyanga region. Participants were individually allocated (1:1:1) to usual care (control group) or to additionally receive a monthly cash incentive for up to 6 months, conditional on clinic attendance, in one of two amounts: 10000 TZS (US $4.50) or 22500 TZS (US $10). Economic outcomes, collected via a questionnaire at baseline and 6 months, included: currently working, functional limitation (missed work due to illness), food insecurity (Household Hunger Scale), and relative wealth (score from principal components analysis). We compared changes in economic outcomes over 6 months using longitudinal regression models with a group-by-time interaction term, including multiple imputation for missing 6-month surveys (10.6%).
RESULTS: From April 24 to December 14, 2018, we randomized 530 participants (184 control, 172 smaller incentive, 174 larger incentive). From baseline to 6 months, overall improvements were observed in the proportions working (from 60% to 72%) and experiencing household hunger (from 27% to 21%), with little difference between study groups. Compared to the control group, functional limitation declined more in the larger incentive group [-10.9 percentage points, 95% CI: -24.4, 2.6; interaction p=0.11] and wealth percentile improved (3.8, 95% CI: -1.0, 8.6; interaction p=0.12).

CONCLUSIONS: Financial incentives to improve retention and ART adherence may have additional benefits for individual and household economic well-being, given a sufficiently large incentive size. These findings contribute further evidence for implementing incentives within HIV care and should be factored into cost-benefit considerations.

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