"It Makes You Feel Like Someone Cares" acceptability of a financial incentive intervention for HIV viral suppression in the HPTN 065 (TLC-Plus) study.
BACKGROUND
HPTN 065 (TLC-Plus) evaluated the feasibility and effectiveness of providing quarterly $70 gift card financial incentives to HIV-infected patients on antiretroviral therapy (ART) to encourage ART adherence and viral suppression, and represents the largest study to-date of a financial incentive intervention for HIV viral suppression. A post-trial qualitative substudy was undertaken to examine acceptability of the financial incentives among those receiving and implementing the intervention.


METHODS
Between July and October 2013, semi-structured interviews were conducted with 72 patients and 12 investigators from 14 sites; three focus groups were conducted with 12 staff from 10 sites. Qualitative data collection elicited experiences with and attitudes about the intervention, including philosophical viewpoints and implementation experiences. Transcripts were analyzed in NVivo 10. Memos and matrices were developed to explore themes from different participant group perspectives.


RESULTS
Patients, investigators, and staff found the intervention highly acceptable, primarily due to the emotional benefits gained through giving or receiving the incentive. Feeling rewarded or cared for was a main value perceived by patients; this was closely tied to the financial benefit for some. Other factors influencing acceptability for all included perceived effectiveness and health-related benefits, philosophical concerns about the use of incentives for health behavior change, and implementation issues. The termination of the incentive at the end of the study was disappointing to participants and unexpected by some, but generally accepted.


CONCLUSIONS
Positive experiences with the financial incentive intervention and strategies used to facilitate implementation led to high acceptability of the intervention, despite some reluctance in principle to the use of incentives. The findings of this analysis provide encouraging evidence in support of the acceptability of a large-scale financial incentive intervention for HIV viral suppression in a clinical setting, and offer valuable lessons for future applications of similar interventions.
Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America.
Elizabeth
E
Greene
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
Allison
A
Pack
Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America.
Jill
J
Stanton
Institute for Reproductive Health, Georgetown University, Washington DC, United States of America.
Victoria
V
Shelus
Social and Behavioral Health Sciences, FHI 360, Durham, North Carolina, United States of America.
Elizabeth E
EE
Tolley
Social and Behavioral Health Sciences, FHI 360, Durham, North Carolina, United States of America.
Jamilah
J
Taylor
ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America.
Wafaa M
WM
El Sadr
Scientific Affairs, LLC, Atlanta, Georgia, United States of America.
Bernard M
BM
Branson
Jacobi Medical Center, New York, New York, United States of America.
Jason
J
Leider
Children's National Health System, Washington DC, United States of America.|Elizabeth Glaser Pediatric AIDS Foundation, Washington DC, United States of America.
Natella
N
Rakhmanina
Science Facilitation Department, FHI 360, Durham, North Carolina, United States of America.
Theresa
T
Gamble
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged
D044966:Anti-Retroviral Agents