Adolescent and young adult preferences for financial incentives to support adherence to antiretroviral therapy in Kenya: a mixed methods study.

Publisher: John Wiley & Sons, Inc Country of Publication: Switzerland NLM ID: 101478566 Publication Model: Print Cited Medium: Internet ISSN: 1758-2652 (Electronic) Linking ISSN: 17582652 NLM ISO Abbreviation: J Int AIDS Soc Subsets: MEDLINE

Publication: 2017- : Hoboken, NJ : John Wiley & Sons, Inc
Original Publication: [London] : BioMed Central

HIV Infections*/drug therapy ; Motivation*; Female ; Focus Groups ; Humans ; Kenya ; Male ; Reward

Introduction: To develop a patient-centred financial incentive delivery strategy to improve antiretroviral treatment adherence in adolescents and young adults (AYA) living with HIV in Kisumu, Kenya, we conducted a mixed methods study exploring preferences.
Methods: A discrete choice experiment (DCE) and focus group discussion (FGD) were conducted simultaneously to identify preferences for five incentive delivery strategy features: value, eligibility, recipient, format and disbursement frequency. We used consecutive sampling to recruit AYA (14-24 years) living with HIV attending three health facilities in Kisumu, Kenya. We calculated mean preferences, willingness to trade, latent class membership and predictors of latent class membership. The FGD explored preferred incentive features, and, after deductive and inductive coding, qualitative findings were triangulated with DCE results.
Results: Two hundred and seven AYA living with HIV (46% 14-17 years, 54% 18-24 years; 33% male sex, 89% viral load <50 copies/ml) were recruited to the study (28 October-16 November 2020). Two distinct preference phenotypes emerged from the DCE analysis (N = 199), 44.8% of the population fell into an "immediate reward" group, who wanted higher value cash or mobile money distributed at each clinic visit, and 55.2% fell into a "moderate spender" group, who were willing to accept lower value incentives in the form of cash or shopping vouchers, and accrued payments. The immediate reward group were willing to trade up to 200 Kenyan Shillings (KSH)-approximately 2 US dollars (USD)-of their 500 KSH (∼5 USD) incentive to get monthly as opposed to accrued yearly payments. The strongest predictor of latent class membership was age (RR 1.45; 95% CI: 1.08-1.95; p = 0.006). Qualitative data highlighted the unique needs of those attending boarding school and confirmed an overwhelming preference for cash incentives which appeared to provide the greatest versatility for use.
Conclusions: Providing small financial incentives as cash was well-aligned with AYA preferences in this setting. AYA should additionally be offered a choice of other incentive delivery features (such as mobile money, recipient and disbursement frequency) to optimally align with the specific needs of their age group and life stage.
(© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)

Lancet Glob Health. 2016 Dec;4(12):e978-e988. (PMID: 27815148)
Value Health. 2011 Jun;14(4):403-13. (PMID: 21669364)
J Acquir Immune Defic Syndr. 2019 Dec;82 Suppl 3:S222-S229. (PMID: 31764258)
J Int AIDS Soc. 2017 May 16;20(Suppl 3):21520. (PMID: 28530036)
BMC Health Serv Res. 2017 Jan 26;17(1):88. (PMID: 28126032)
J Subst Use. 2016 Nov 1;21(6):662-668. (PMID: 27695386)
EClinicalMedicine. 2020 Nov 30;29-30:100653. (PMID: 33305199)
Lancet HIV. 2018 Feb;5(2):e79-e86. (PMID: 29170030)
Curr Opin Behav Sci. 2015 Oct 1;5:108-115. (PMID: 26665151)
BMC Int Health Hum Rights. 2014 Apr 01;14:10. (PMID: 24690131)
AIDS Behav. 2022 Mar;26(3):833-842. (PMID: 34453239)
BMC Health Serv Res. 2017 Apr 26;17(1):306. (PMID: 28446232)
J Int AIDS Soc. 2020 Nov;23(11):e25636. (PMID: 33247553)
J Med Ethics. 2017 Mar;43(3):145-149. (PMID: 27645199)
Vulnerable Child Youth Stud. 2020;15(3):257-268. (PMID: 33281920)
JAMA. 2007 Nov 28;298(20):2415-7. (PMID: 18042920)
Cochrane Database Syst Rev. 2016 Nov 08;11:CD006417. (PMID: 27824221)
AIDS Behav. 2013 Sep;17(7):2283-92. (PMID: 23370833)
Value Health. 2013 Jan-Feb;16(1):3-13. (PMID: 23337210)
Health Econ Rev. 2019 Oct 30;9(1):30. (PMID: 31667632)
Soc Sci Med. 2020 Nov;265:113333. (PMID: 32896799)
Curr Opin HIV AIDS. 2018 May;13(3):212-219. (PMID: 29570471)
PLoS Med. 2021 Sep 28;18(9):e1003509. (PMID: 34582433)
J Acquir Immune Defic Syndr. 2019 Dec;82 Suppl 3:S183-S191. (PMID: 31764253)
PLoS Med. 2019 Dec 31;16(12):e1003020. (PMID: 31891581)
Curr HIV/AIDS Rep. 2020 Oct;17(5):467-477. (PMID: 32860150)
JAMA. 2020 Aug 18;324(7):700-701. (PMID: 32808993)
Adm Policy Ment Health. 2011 Jan;38(1):44-53. (PMID: 20967495)
PLoS One. 2014 Jan 02;9(1):e84317. (PMID: 24392124)

K24 AI134413 United States AI NIAID NIH HHS; R01 NR018801 United States NR NINR NIH HHS; KL2 TR002346 United States TR NCATS NIH HHS

Keywords: HIV; adolescent; antiretroviral; discrete choice; incentive; preference

Date Created: 20220915 Date Completed: 20220919 Latest Revision: 20231101

20250114

PMC9478044

10.1002/jia2.25979

36109803