The Role of Financial Incentives Along the Antiretroviral Therapy Adherence Continuum: A Qualitative Sub-study of the HPTN 065 (TLC-Plus) Study
The stages of change (SOC) theory suggests individuals adapt incrementally to behaviors like adherence, requiring different strategies over the behavior change continuum. Offering financial incentives (FIs) is one strategy to motivate adherence. This qualitative sub-study examined adherence barriers...
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Published in | AIDS and behavior Vol. 22; no. 1; pp. 245 - 257 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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New York
Springer US
01.01.2018
Springer Nature B.V |
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Abstract | The stages of change (SOC) theory suggests individuals adapt incrementally to behaviors like adherence, requiring different strategies over the behavior change continuum. Offering financial incentives (FIs) is one strategy to motivate adherence. This qualitative sub-study examined adherence barriers and the role of FIs to increase viral suppression (VS) among HIV Prevention Trials Network (HPTN) 065 study participants categorized into SOC-related adherence stages based on changes from baseline to follow-up viral load tests. Of 73 participants, most were in Maintenance stage (n = 31), defined as having achieved VS throughout HPTN 065, or in Action stage (n = 29), defined as moving from virally unsuppressed to suppressed in 50% or more of tests. Only 13 were Low Adherers, having achieved VS in fewer than 50% of tests. The latter group faced substantial social and structural adherence barriers. Participants in the Action stage made positive changes to adherence routines to achieve VS. Those in Maintenance were less incentivized by FIs, as they were already committed. Results from this sub-study suggest FI effectiveness may vary across the SOC continuum, with greatest impact for those initiating antiretroviral or without explicit adherence routines. FIs may be insufficient to overcome strong social or structural barriers, and unnecessary for those intrinsically committed to remaining adherent. |
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AbstractList | The stages of change (SOC) theory suggests individuals adapt incrementally to behaviors like adherence, requiring different strategies over the behavior change continuum. Offering financial incentives (FIs) is one strategy to motivate adherence. This qualitative sub-study examined adherence barriers and the role of FIs to increase viral suppression (VS) among HIV Prevention Trials Network (HPTN) 065 study participants categorized into SOC-related adherence stages based on changes from baseline to follow-up viral load tests. Of 73 participants, most were in Maintenance stage (n = 31), defined as having achieved VS throughout HPTN 065, or in Action stage (n = 29), defined as moving from virally unsuppressed to suppressed in 50% or more of tests. Only 13 were Low Adherers, having achieved VS in fewer than 50% of tests. The latter group faced substantial social and structural adherence barriers. Participants in the Action stage made positive changes to adherence routines to achieve VS. Those in Maintenance were less incentivized by FIs, as they were already committed. Results from this sub-study suggest FI effectiveness may vary across the SOC continuum, with greatest impact for those initiating antiretroviral or without explicit adherence routines. FIs may be insufficient to overcome strong social or structural barriers, and unnecessary for those intrinsically committed to remaining adherent. The stages of change (SOC) theory suggests individuals adapt incrementally to behaviors like adherence, requiring different strategies over the behavior change continuum. Offering financial incentives (FIs) is one strategy to motivate adherence. This qualitative sub-study examined adherence barriers and the role of FIs to increase viral suppression (VS) among HIV Prevention Trials Network (HPTN) 065 study participants categorized into SOC-related adherence stages based on changes from baseline to follow-up viral load tests. Of 73 participants, most were in Maintenance stage (n = 31), defined as having achieved VS throughout HPTN 065, or in Action stage (n = 29), defined as moving from virally unsuppressed to suppressed in 50% or more of tests. Only 13 were Low Adherers, having achieved VS in fewer than 50% of tests. The latter group faced substantial social and structural adherence barriers. Participants in the Action stage made positive changes to adherence routines to achieve VS. Those in Maintenance were less incentivized by FIs, as they were already committed. Results from this sub-study suggest FI effectiveness may vary across the SOC continuum, with greatest impact for those initiating antiretroviral or without explicit adherence routines. FIs may be insufficient to overcome strong social or structural barriers, and unnecessary for those intrinsically committed to remaining adherent. |
Author | Gamble, Theresa Shelus, Victoria El-Sadr, Wafaa M. Stanton, Jill Tolley, Elizabeth E. Branson, Bernard Hodge, Theo Taylor, Jamilah Dunner, Richard Pack, Allison Greene, Elizabeth |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28612215$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1080_09540121_2020_1828799 crossref_primary_10_1016_S2352_3018_18_30357_6 crossref_primary_10_1007_s10865_020_00186_7 crossref_primary_10_1097_QAI_0000000000001927 crossref_primary_10_1007_s10995_019_02766_9 crossref_primary_10_1002_14651858_CD013635_pub2 crossref_primary_10_1007_s10461_020_02811_7 crossref_primary_10_1177_0956462419867573 crossref_primary_10_1007_s10461_022_03644_2 crossref_primary_10_1007_s11904_022_00615_z crossref_primary_10_1371_journal_pone_0270180 |
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Keywords | Adherence Financial incentives Stage of change HIV United States |
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SubjectTerms | Adult Anti-Retroviral Agents - therapeutic use Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Antiretroviral Therapy, Highly Active Barriers Behavior modification Female Health Psychology HIV HIV Infections - drug therapy HIV Infections - psychology HIV Infections - virology Human immunodeficiency virus Humans Incentives Infectious Diseases Load tests Maintenance Male Medication Adherence Medicine Medicine & Public Health Middle Aged Monetary incentives Motivation North Carolina Original Paper Pain Management Patient compliance Prescription drugs Public Health Qualitative Research Remuneration Routines Viral Load Young Adult |
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Title | The Role of Financial Incentives Along the Antiretroviral Therapy Adherence Continuum: A Qualitative Sub-study of the HPTN 065 (TLC-Plus) Study |
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