With HIV, Love Beats Cash

New research has uncovered some surprising results in terms of what motivates people living with HIV to adhere to their antiretroviral therapy (ART) — and it isn’t cash alone. A recent study based out of publicly-funded clinic in Atlanta Georgia showed that people who chose to enter into a commitment contract to adhere to their ART, in addition to receiving cash incentives, were more likely to continue adherence and achieve viral suppression after the cash incentives were stopped.

The participants, who were all patients that had detectable viral loads despite at least six months on ART, were divided into three groups. In the first two arms of the study, participants were given cash incentives. The first arm of the study gave participants $30 for attending scheduled provider visits. The people in the second arm were given a choice between this first arrangement, or committing to a contract that made the $30 payment conditional on both attending the provider visits and meeting an ART adherence threshold. The third arm participants were given regular care without cash incentives.

The study required participants to attend five provider visits. At the time of the fifth scheduled visit and the last time the participants would receive the cash payment, viral load results were not significantly different. 42% of the people who entered into commitment contracts had viral suppression, 38% of people who received incentives for attending appointments had viral suppression, and 34% of individuals who received no cash incentives were virally suppressed.

Now here’s where it gets interesting. Researchers surprised the participants with a sixth, unscheduled visit three months after the cash incentives had stopped. At this time, the results varied quite significantly. 68% of patients in the adherence agreement arm were virally suppressed, compared to 43% of patients in the appointment incentive arm and 41% of patients in unpaid arm. The chances of viral suppression did not differ much in the last two groups, however, the patients who had entered into the adherence contracts were approximately four times more likely to have viral suppression.

“Commitment contracts can improve ART adherence and virological suppression,” concluded the authors of the study, in a report by aidsmap. The researchers theorized that because those who entered into the commitment contracts chose to do so on their own, they had a greater sense of personal empowerment in management of their condition.