Abstract
Behavioral economics (BE) has been used to study a number of health behaviors such as smoking and drug use, but there is little knowledge of how these insights relate to HIV prevention and care. We present novel evidence on the prevalence of the common behavioral decision-making errors of present-bias, overoptimism, and information salience among 155 Ugandan HIV patients, and analyze their association with subsequent medication adherence. 36 % of study participants are classified as present-biased, 21 % as overoptimistic, and 34 % as having salient HIV information. Patients displaying present-bias were 13 % points (p = 0.006) less likely to have adherence rates above 90 %, overoptimistic clients were 9 % points (p = 0.04) less likely, and those not having salient HIV information were 17 % points (p < 0.001) less likely. These findings indicate that BE may be used to screen for future adherence problems and to better design and target interventions addressing these behavioral biases and the associated suboptimal adherence.
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Acknowledgments
We would like to thank Mildmay Clinic under the leadership of Dr. Barbara Mukasa and study coordinator Tonny Kizza for their invaluable help in implementing the study. Thanks to Dr. Glenn Wagner, Dr. Arleen Leibowitz and Dr. Tom Rice for comments on an early draft, and two referees for insightful comments. Our gratitude goes most importantly to the study participants who gave so generously of their time and insights. This project was funded by the National Institute of Mental Health (NIMH), Grant Number R34MH096609. Sebastian Linnemayr is the principal investigator for the NIMH grant, and organized and coordinated the data collection efforts at the Mildmay Clinic in Kampala, Uganda. Both authors contributed equally to the data analyses and writing the paper. In memory of Esther Kawuma who made this study possible and who will be dearly missed by the RAND team.
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Linnemayr, S., Stecher, C. Behavioral Economics Matters for HIV Research: The Impact of Behavioral Biases on Adherence to Antiretrovirals (ARVs). AIDS Behav 19, 2069–2075 (2015). https://doi.org/10.1007/s10461-015-1076-0
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DOI: https://doi.org/10.1007/s10461-015-1076-0