Simple Incentives Boost HIV Drug Adherence

Researchers are finding that simple incentives like umbrellas and mugs make a difference in educating Africans about HIV drug adherence. On April 18, Mildmay Uganda and the the United States-based RAND Corporation launched a research study called Behavioral Economics Incentives to Support HIV Treatment Adherence in sub-Saharan Africa (BEST). The study will span over five years and study how rewards affect and improve antiretroviral (ARV) drug adherence.

Adherence to ARVs, according to numerous world agencies, is one of the most important factors throughout the entire process that determines the overall outcome for people living with HIV.

Estimates indicate that Uganda is home to 1.3 million people living with HIV, representing a prevalence of HIV at six percent. Although Uganda has been recognized by the World Health Organization (WHO) as one of the countries in sub-Saharan Africa that has recently excelled in the elimination of mother-to-child transmission of HIV, several other problems persist.

A handful of HIV treatment studies by Makerere University, Mildmay and the Ministry of Health have already indicated that people living with HIV were developing drug resistance to first-line regimen as a result of skipping days of their prescribed drugs. This study, however, will focus on a potential solution.

The study will recruit about 330 participants in randomized sample, and patients will be rewarded annually based on suppression of their viral loads. The study will monitor patients in three ways: their standard of care, the patient’s viral loads and through the use of Medical Electronic Monitoring devices (MEMs cup). MEMs cups contain a tracking device and can monitor a patient’s drug intake and how well they avoid skipping days of medication.

Harriet Chemusto is an epidemiologist at Mildmay and believes that small changes in adherence reminders and incentives can amount to enormous changes in the health of people living with HIV.

“We want to reward people whose viral load has been suppressed and to encourage them to continue taking their drugs. Whereas many patients get tired of taking drugs, giving them small gifts such as umbrellas and tea bags as a token of appreciation helps them realize how adherence is good,” Chemusto told Uganda’s leading daily paper New Vision. According to Chemusto, small prizes amount to enough motivation to avoid skipping days, providing rewards.

Adherence is especially important in sub-Saharan Africa because of the limited resources of second-line drugs. In the United States, it’s common for people living with HIV to be bumped to another drug after skipping days of medication and developing a permanent resistance to certain medications. But many of those drugs simply don’t exist in Uganda.

The people behind this study hope to make a change by determining if small incentives work as a solution. There are plenty of theories to go around, but little empirical evidence exists to back up any potential solution.

The RAND Corporation is a global nonprofit think tank based out of Santa Monica, California and provides research to multiple government agencies. The corporation is financed by the U.S. government and private endowments.

Adherence in ARVs , like antibiotics, is much more important than conventional drugs. It takes religious consistency in order to make sure that the drugs work. And the problem isn’t limited to sub-Saharan Africa. Americans, especially those who take illicit drugs, are prone to skip daily combination pills, and each time we forget, our chances of developing a resistance over time increases.