Skip to main content

Advertisement

SpringerLink
Log in

Conditional Economic Incentives to Improve HIV Treatment Adherence: Literature Review and Theoretical Considerations

  • Substantive Review
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

We present selected theoretical issues regarding conditional economic incentives (CEI) for HIV treatment adherence. High HIV treatment adherence is essential not only to improve individual health for persons living with HIV, but also to reduce transmission. The incentives literature spans several decades and various disciplines, thus we selectively point out useful concepts from economics, psychology and HIV clinical practice to elucidate the complex interaction between socio-economic issues, psychological perspectives and optimal treatment adherence. Appropriately-implemented CEI can help patients improve their adherence to HIV treatment in the short-term, while the incentives are in place. However, more research is needed to uncover mechanisms that can increase habit formation or maintenance effects in the longer-term. We suggest some potentially fruitful avenues for future research in this area, including the use of concepts from self-determination theory. This general framework may have implications for related research among disadvantaged communities with high rates of HIV/AIDS infection.

Resumen

Se presentan aspectos teóricos sobre incentivos económicos condicionados para la adherencia al tratamiento del VIH. Una alta adherencia al tratamiento antirretroviral es esencial para mantener la salud de las personas que viven con el VIH y también para reducir la transmisión del virus. La literatura de incentivos abarca varias décadas y disciplinas diferentes, por lo que selectivamente se señalan conceptos útiles de la economía, la psicología y el tratamiento clínico del VIH para dilucidar la compleja interacción entre el entorno socioeconómico, la perspectiva psicológica y la adherencia óptima al tratamiento. Programas de incentivos adecuadamente implementados pueden ayudar a los pacientes a mejorar su adherencia al tratamiento del VIH en el corto plazo, mientras los incentivos se mantienen. Sin embargo, se requieren más estudios para descubrir los mecanismos que promueven la formación de hábitos a largo plazo. Se sugieren áreas para investigaciones futuras como la incorporación de conceptos de la teoría de la autodeterminación. Este marco conceptual general puede ser aplicado a la investigación con las poblaciones más desfavorecidas y las tasas más altas de VIH/SIDA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Hogg RS, Heath KV, Yip B, et al. Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA. 1998;279(6):450–4.

    Article  PubMed  CAS  Google Scholar 

  2. Hammer SM, Squires KE, Hughes MD, et al. A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS clinical trials group 320 study team. N Engl J Med. 1997;337(11):725–33.

    Article  PubMed  CAS  Google Scholar 

  3. Hirsch M, Steigbigel R, Staszewski S, et al. A randomized, controlled trial of indinavir, zidovudine, and lamivudine in adults with advanced human immunodeficiency virus type 1 infection and prior antiretroviral therapy. J Infect Dis. 1999;180(3):659–65.

    Article  PubMed  CAS  Google Scholar 

  4. Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.

    Article  PubMed  CAS  Google Scholar 

  5. Simoni JM, Amico KR, Pearson CR, Malow R. Strategies for promoting adherence to antiretroviral therapy: a review of the literature. Curr Infect Dis Rep. 2008;10(6):515–21.

    Article  PubMed  Google Scholar 

  6. Haug NA, Sorensen JL, Gruber VA, Lollo N, Roth G. HAART adherence strategies for methadone clients who are HIV-positive: a treatment manual for implementing contingency management and medication coaching. Behav Modif. 2006;30(6):752–81.

    Article  PubMed  Google Scholar 

  7. Haug NA, Sorensen JL. Contingency management interventions for HIV-related behaviors. Curr HIV/AIDS Rep. 2006;3(4):154–9.

    Article  PubMed  Google Scholar 

  8. Rosen MI, Dieckhaus K, McMahon TJ, et al. Improved adherence with contingency management. AIDS Patient Care STDs. 2007;21(1):30–40.

    Article  PubMed  Google Scholar 

  9. Sorensen JL, Haug NA, Delucchi KL, et al. Voucher reinforcement improves medication adherence in HIV-positive methadone patients: a randomized trial. Drug Alcohol Depend. 2007;88(1):54–63.

    Article  PubMed  Google Scholar 

  10. Petry NM, Rash CJ, Byrne S, Ashraf S, White WB. Financial reinforcers for improving medication adherence: findings from a meta-analysis. Am J Med. 2012;125(9):888–96.

    Article  PubMed  Google Scholar 

  11. Defulio A, Silverman K. The use of incentives to reinforce medication adherence. Prev Med. 2012;. doi:10.1016/j.ypmed.2012.04.017.

    Google Scholar 

  12. Griffith JD, Rowan-Szal GA, Roark RR, Simpson DD. Contingency management in outpatient methadone treatment: a meta-analysis. Drug Alcohol Depend. 2000;58(2-Jan):55–66.

    Article  PubMed  CAS  Google Scholar 

  13. Lussier JP, Heil SH, Mongeon JA, Badger GJ, Higgins ST. A meta-analysis of voucher-based reinforcement therapy for substance use disorders. Addiction. 2006;101(2):192–203.

    Article  PubMed  Google Scholar 

  14. Prendergast M, Podus D, Finney J, Greenwell L, Roll J. Contingency management for treatment of substance use disorders: a meta-analysis. J Subst Abuse Treat. 2006;101(11):1546–60.

    Google Scholar 

  15. Dutra L, Stathopoulou G, Basden SL, Leyro TM, Powers MB, Otto MW. A meta-analytic review of psychosocial interventions for substance use disorders. Am J Psychiatry. 2008;165(2):179–87.

    Article  PubMed  Google Scholar 

  16. Higgins ST, Silverman K, Heil SH, editors. Contingency management in substance abuse treatment. New York: Guilford Press; 2008.

    Google Scholar 

  17. Dallery J, Meredith SE, Budney AJ. Contingency management in substance abuse treatment. In: Walters ST, Rotgers F, editors. Treating substance abuse: theory and technique. 3rd ed. New York: Guilford Press; 2012.

    Google Scholar 

  18. Giuffrida A, Torgerson DJ. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315(7110):703–7.

    Article  PubMed  CAS  Google Scholar 

  19. Fiszbein A, Schady N, Ferreira FHG. Conditional cash transfers: reducing present and future poverty [Chapter 2: Economic Rationale]. Washington D.C.: World Bank; 2009.

    Book  Google Scholar 

  20. Loewenstein G, Brennan T, Volpp KG. Asymmetric paternalism to improve health behaviors. JAMA. 2007;298(20):2415–7.

    Article  PubMed  CAS  Google Scholar 

  21. Rabin M. Psychology and economics. J Econ Lit. 1998;36(1):11–46.

    Google Scholar 

  22. DellaVigna S. Psychology and economics: evidence from the field. J Econ Lit. 2009;47(2):315–72.

    Article  Google Scholar 

  23. Frederick S, Loewenstein G, O’Donoghue T. Time discounting and time preference: a critical review. J Econ Lit. 2002;40(2):351–401.

    Article  Google Scholar 

  24. Laibson D. Golden eggs and hyperbolic discounting. Q J Econ. 1997;112(2):443–77.

    Article  Google Scholar 

  25. Zimbardo PG, Boyd JN. Putting time in perspective: a valid, reliable individual-differences metric. J Pers Soc Psychol. 1999;77(6):1271–88.

    Article  Google Scholar 

  26. Boyd JN, Zimbardo PG. Time perspective, health, and risk taking. In: Strathman A, Joireman J, editors. Understanding behavior in the context of time: theory, research, and application. Mahwah: Lawrence Erlbaum Associates; 2005.

    Google Scholar 

  27. Murphy JG, MacKillop J, Vuchinich RE, Tucker JA. The behavioral economics of substance abuse. In: Walters ST, Rotgers F, editors. Treating substance abuse: theory and technique. 3rd ed. New York: Guilford; 2012.

    Google Scholar 

  28. Marshall A. Principles of economics. London and New York: Macmillan; 1890.

    Google Scholar 

  29. Strecher VJ, Rosenstock IM. The health belief model. In: Glanz K, Lewis FM, editors. Health behavior and health education: theory, research and practice. San Francisco: Jossey-Bass; 1997.

    Google Scholar 

  30. Deci EL, Ryan RM. A motivational approach to self: integration in personality. Nebr Symp Motiv. 1990;38:237–88.

    PubMed  CAS  Google Scholar 

  31. Deci EL, Koestner R, Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull. 1999;125(6):627–68. discussion 692-700.

    Article  PubMed  CAS  Google Scholar 

  32. Ryan RM, Deci EL. Intrinsic and extrinsic motivations: classic definitions and new directions. Contemp Educ Psychol. 2000;25(1):54–67.

    Article  PubMed  Google Scholar 

  33. Deci EL, Ryan RM. The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychol Inq. 2000;11(4):227–68.

    Article  Google Scholar 

  34. Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49(3):182–5.

    Article  Google Scholar 

  35. Rigby CS, Deci EL, Patrick BC, Ryan RM. Beyond the intrinsic extrinsic dichotomy—self-determination in motivation and learning. Motiv Emotion. 1992;16(3):165–85.

    Article  Google Scholar 

  36. Cameron J. Negative effects of reward on intrinsic motivation—A limited phenomenon: comment on Deci, Koestner, and Ryan (2001). Rev Educ Res. 2001;71(1):29–42.

    Article  Google Scholar 

  37. Cameron J, Banko KM, Pierce WD. Pervasive negative effects of rewards on intrinsic motivation: the myth continues. Behav Analyst. 2001;24(1):1–44.

    CAS  Google Scholar 

  38. Pierce WD, Cameron J, Banko KM, So S. Positive effects of rewards and performance standards on intrinsic motivation. Psychol Rec. 2003;53:561–79.

    Google Scholar 

  39. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol. 2009;64(6):527–37.

    Article  PubMed  Google Scholar 

  40. Williams GC, Rodin GC, Ryan RM, Grolnick WS, Deci EL. Autonomous regulation and long-term medication adherence in adult outpatients. Health Psychol. 1998;17(3):269–76.

    Article  PubMed  CAS  Google Scholar 

  41. Ryan RM, Deci EL. Self-regulation and the problem of human autonomy: does psychology need choice, self-determination, and will? J Pers. 2006;74(6):1557–85.

    Article  PubMed  Google Scholar 

  42. DiIorio C, McCarty F, Resnicow K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care. 2008;20(3):273–83.

    Article  PubMed  CAS  Google Scholar 

  43. Bandura A. Social learning theory. Englewood Cliffs: Prentice Hall; 1977.

    Google Scholar 

  44. Azjen I, Fishbein M. Understanding attitudes and predicting social behavior. Englewood Cliffs: Prentice-Hall; 1980.

    Google Scholar 

  45. Prochaska JO, Norcross JC, DiClemente CC. Changing for good: the revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits. New York: W. Morrow; 1994.

    Google Scholar 

  46. Prochaska JO, DiClemente CC. The transtheoretical approach: crossing traditional boundaries of therapy. Homewood: Dow Jones-Irwin; 1984.

    Google Scholar 

  47. Roozen HG, Boulogne JJ, van Tulder MW, van den Brink W, De Jong CA, Kerkhof AJ. A systematic review of the effectiveness of the community reinforcement approach in alcohol, cocaine and opioid addiction. Drug Alcohol Depend. 2004;74(1):1–13.

    Article  PubMed  Google Scholar 

  48. Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;Spec No:80-94.

  49. Farmer P. Social scientists and the new tuberculosis. Soc Sci Med. 1997;44:347–58.

    Article  PubMed  CAS  Google Scholar 

  50. Simoni JM, Huh D, Frick PA, et al. Peer support and pager messaging to promote antiretroviral modifying therapy in Seattle: a randomized controlled trial. J Acquir Immune Defic Syndr. 2009;52(4):465–73.

    Article  PubMed  Google Scholar 

  51. Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25(1):74–81.

    Article  PubMed  Google Scholar 

  52. Koenig LJ, Pals SL, Bush T, Pratt Palmore M, Stratford D, Ellerbrock TV. Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy. Health Psychol. 2008;27(2):159–69.

    Article  PubMed  Google Scholar 

  53. Deering KN, Shannon K, Sinclair H, Parsad D, Gilbert E, Tyndall MW. Piloting a peer-driven intervention model to increase access and adherence to antiretroviral therapy and HIV care among street-entrenched HIV-positive women in Vancouver. AIDS Patient Care STDs. 2009;23(8):603–9.

    Article  PubMed  Google Scholar 

  54. DiMatteo MR. Social support and patient adherence to medical treatment: a meta-analysis. Health Psychol. 2004;23(2):207–18.

    Article  PubMed  Google Scholar 

  55. Ware NC, Idoko J, Kaaya S, et al. Explaining adherence success in sub-Saharan Africa: an ethnographic study. PLoS Med. 2009;6(1):e11.

    Article  PubMed  Google Scholar 

  56. Bandura A. Human agency in social cognitive theory. Am Psychol. 1989;44(9):1175–84.

    Article  PubMed  CAS  Google Scholar 

  57. Fisher JD, Amico KR, Fisher WA, Harman JJ. The information-motivation-behavioral skills model of antiretroviral adherence and its applications. Curr HIV/AIDS Rep. 2008;5(4):193–203.

    Article  PubMed  Google Scholar 

  58. Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25(4):462–73.

    Article  PubMed  Google Scholar 

  59. Bury M. Chronic illness as biographical disruption. Sociol Health Illn. 1982;4:167–82.

    Article  PubMed  CAS  Google Scholar 

  60. Charmaz K. Loss of self: a fundamental form of suffering in the chronically ill. Sociol Health Illn. 1983;5:168–95.

    Article  PubMed  CAS  Google Scholar 

  61. Aujoulat I, Marcolongo R, Bonadiman L, Deccache A. Reconsidering patient empowerment in chronic illness: a critique of models of self-efficacy and bodily control. Soc Sci Med. 2008;66:1228–39.

    Article  PubMed  Google Scholar 

  62. Baumgartner LM. The incorporation of the HIV/AIDS identity into the self over time. Qual Health Res. 2007;17:919–31.

    Article  PubMed  Google Scholar 

  63. Serpe RT. Stability and change in self: a structural symbolic interactionist explanation. Soc Psychol Q. 1987;50:44–55.

    Article  Google Scholar 

  64. Auld MC. Disentangling the effects of morbidity and life expectancy on labor market outcomes. Health Econ. 2002;11(6):471–83.

    Article  PubMed  Google Scholar 

  65. Rigsby MO, Rosen MI, Beauvais JE, et al. Cue-dose training with monetary reinforcement: pilot study of an antiretroviral adherence intervention. J Gen Int Med. 2000;15(12):841–7.

    Article  CAS  Google Scholar 

  66. Javanbakht M, Prosser P, Grimes T, Weinstein M, Farthing C. Efficacy of an individualized adherence support program with contingent reinforcement among nonadherent HIV-positive patients: results from a randomized trial. J Int Phys AIDS Care. 2006;5(4):143–50.

    Google Scholar 

  67. Charness G, Gneezy U. Incentives to exercise. Econometrica. 2009;77(3):909–31.

    Article  Google Scholar 

  68. Roll JM, Higgins ST, Badger GJ. An experimental comparison of three different schedules of reinforcement of drug abstinence using cigarette smoking as an exemplar. J Appl Behav Anal. 1996;29(4):495–504. quiz 504-5.

    Article  PubMed  CAS  Google Scholar 

  69. Deren S, Stephens R, Davis WR, Feucht TE, Tortu S. The impact of providing incentives for attendance at AIDS prevention sessions. Public Health Rep. 1994;109(4):548–54.

    PubMed  CAS  Google Scholar 

  70. Kamb ML, Rhodes F, Hoxworth T, et al. What about money? Effect of small monetary incentives on enrollment, retention, and motivation to change behaviour in an HIV/STD prevention counselling intervention. The Project RESPECT Study Group. Sex Transm Infect. 1998;74(4):253–5.

    Article  PubMed  CAS  Google Scholar 

  71. Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: translating research findings to the real world clinic. Curr HIV/AIDS Rep. 2010;7(1):44–51.

    Article  PubMed  Google Scholar 

  72. McNairy ML, El-Sadr WM. The HIV care continuum: no partial credit given. AIDS. 2012;26(14):1735–8.

    Article  PubMed  Google Scholar 

  73. Benabou R, Tirole J. Intrinsic and extrinsic motivation. Rev Econ Stud. 2003;70(3):489–520.

    Article  Google Scholar 

  74. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We thank Don Operario and Caroline Kuo for helpful discussions; and Gary Rose for comments on an earlier draft. This work was supported in part by the National Institutes of Health/Fogarty International Center (K01-TW008016-04) that provided support for Dr. Galárraga; and also by a training grant from the Agency for Healthcare Research and Quality (1T32HS019657-01) that provided support for Dr. Genberg.

Author information

Authors and Affiliations

  1. Department of Health Services, Policy & Practice, Brown University, Box G-S121-7, 121 South Main Street, Providence, RI, 02912, USA

    Omar Galárraga, Becky L. Genberg, M. Barton Laws & Ira B. Wilson

  2. Department of Behavioral and Social Sciences, Brown University, Providence, RI, 02912, USA

    Rosemarie A. Martin

  3. The Warren Alpert Medical School, Brown University, Providence, RI, 02912, USA

    Ira B. Wilson

Authors
  1. Omar Galárraga
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Becky L. Genberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosemarie A. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Barton Laws
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ira B. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Omar Galárraga.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Galárraga, O., Genberg, B.L., Martin, R.A. et al. Conditional Economic Incentives to Improve HIV Treatment Adherence: Literature Review and Theoretical Considerations. AIDS Behav 17, 2283–2292 (2013). https://doi.org/10.1007/s10461-013-0415-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-013-0415-2

Keywords

Palabras Clave

Search

Navigation