Keywords
behavioral economics, commitment contract, financial incentives, antiretroviral therapy, adherence, HIV-1 virologic suppression
Abstract
Objective—Assess whether a commitment contract informed by behavioral economics leads to persistent virologic suppression among HIV-positive patients with poor antiretroviral therapy (ART) adherence.
Design—Single-center pilot randomized clinical trial, plus a non-randomized control group.
Setting—Publicly-funded HIV clinic in Atlanta, Georgia, USA.
Intervention—The study involved three arms. (i) Participants in the provider visit incentive arm received $30 after attending each scheduled provider visit. (ii) Participants in the incentive choice arm were given a choice between the above arrangement and a commitment contract that made the $30 payment conditional on both attending the provider visit and meeting an ART adherence threshold. (iii) The passive control arm received routine care and no incentives.
Participants—110 HIV-infected adults with a recent plasma HIV-1 viral load (pVL) >200 copies/mL despite ART. The sample sizes of the three groups were as follows: provider visit incentive, n=21; incentive choice, n=19; passive control, n=70.
Main outcome measure—Virologic suppression (pVL≤200 copies/mL) at the end of the incentive period and at an unanticipated post-incentive study visit approximately three months later.
Results—The odds of suppression were higher in the incentive choice arm than in the passive control arm at the post-incentive visit (adjusted odds ratio 3.93, 95%CI 1.19 to 13.04, p=0.025). The differences relative to the passive control arm at the end of the incentive period and relative to the provider visit incentive arm at both points in time were not statistically significant.
Conclusion—Commitment contracts can improve ART adherence and virologic suppression.
Original Publication Citation
“A Commitment Contract to Achieve Virologic Suppression in Poorly Adherent Patients with HIV/AIDS.” 2017. AIDS 31(12):1765-1769 (with Marcella Alsan, John Beshears, Wendy S. Armstrong, James J. Choi, Brigitte C. Madrian, Minh Ly T Nguyen, Carlos Del Rio, David Laibson and Vincent C Marconi). http://dx.doi.org/10.1097/QAD.0000000000001543
BYU ScholarsArchive Citation
Alsan, Marcella; Beshears, John; Armstrong, Wendy S.; Choi, James J.; Madrian, Brigitte C.; Nguyen, Minh Ly T.; Del Rio, Carlos; Laibson, David; and Marconi, Vincent C., "A Commitment Contract to Achieve Virologic Suppression in Poorly Adherent Patients with HIV/AIDS" (2017). Faculty Publications. 9027.
https://scholarsarchive.byu.edu/facpub/9027
Document Type
Peer-Reviewed Article
Publication Date
2017
Publisher
AIDS 31
Language
English
College
Marriott School of Business
Department
Finance
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