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

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.

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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.

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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

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