title: It helps me live, sends my children to school, and feeds me: a qualitative study of how food and cash incentives may improve adherence to treatment and care among adults living with HIV in Tanzania.
abstract: Financial and in-kind incentives have been shown to improve outcomes along the HIV care cascade, however the potential mechanismsthrough which they work remain unclear. To identify the pathways through which incentives improve retention in care and adherence to antiretroviral therapy (ART), we conducted a qualitative study with participants in a trial evaluating conditional food and cash incentives for HIV-positive food insecure adults in Shinyanga, Tanzania. We found that the incentives acted through three pathways to potentially increase retention in care and adherence to ART: (1) addressing competing needs and offsetting opportunity costs associated with clinic attendance, (2) alleviating stress associated with attending clinic and meeting basic needs, and (3) by potentially increasing motivation. Participants did not report any harmful events associated with the incentives, but reported myriad beneficial effects on household welfare. Understanding how incentives are used and how they impact outcomes can improve the design of future interventions.
authors.affiliation: a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Czaicki
authors.affiliation: b Regional Medical Office, Ministry of Health, Community Development, Gender, Elderly, and Children , Shinyanga , Tanzania.
authors.forename: Agatha
authors.initials: A
authors.lastname: Mnyippembe
authors.affiliation: a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA.|c The Sea Change Program , Berkeley , CA , USA.
authors.forename: Madeline
authors.initials: M
authors.lastname: Blodgett
authors.affiliation: d Prevention of Mother-to-Child HIV Transmission Programme, Ministry of Health, Community Development, Gender, Elderly, and Children , Dar es Salaam , Tanzania.
authors.forename: Prosper
authors.initials: P
authors.lastname: Njau
authors.affiliation: a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
mesh_terms: D000328:Adult; D002648:Child; D005191:Family Characteristics; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009042:Motivation; D036301:Qualitative Research; D012574:Schools; D013636:Tanzania; D016903:Drug Monitoring
keywords: ART adherence; HIV infection; Tanzania; cash transfers; food assistance; incentives; qualitative; retention