Abstract
The stages of change (SOC) theory suggests individuals adapt incrementally to behaviors like adherence, requiring different strategies over the behavior change continuum. Offering financial incentives (FIs) is one strategy to motivate adherence. This qualitative sub-study examined adherence barriers and the role of FIs to increase viral suppression (VS) among HIV Prevention Trials Network (HPTN) 065 study participants categorized into SOC-related adherence stages based on changes from baseline to follow-up viral load tests. Of 73 participants, most were in Maintenance stage (n = 31), defined as having achieved VS throughout HPTN 065, or in Action stage (n = 29), defined as moving from virally unsuppressed to suppressed in 50% or more of tests. Only 13 were Low Adherers, having achieved VS in fewer than 50% of tests. The latter group faced substantial social and structural adherence barriers. Participants in the Action stage made positive changes to adherence routines to achieve VS. Those in Maintenance were less incentivized by FIs, as they were already committed. Results from this sub-study suggest FI effectiveness may vary across the SOC continuum, with greatest impact for those initiating antiretroviral or without explicit adherence routines. FIs may be insufficient to overcome strong social or structural barriers, and unnecessary for those intrinsically committed to remaining adherent.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 245-257 |
| Number of pages | 13 |
| Journal | AIDS and behavior |
| Volume | 22 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2018 |
Funding
Acknowledgements The HIV Prevention Trials Network (HPTN) 065 Study is sponsored by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the National Institute on Drug Abuse, of the US National Institutes of Health, under Cooperative Agreements #UM1 AI 068619 and UM1 AI 068617, as well as the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, or the Centers for Disease Control and Prevention. We would like to thank the qualitative data collectors Abby Krumholz, Althea Anderson, Dionne Otey, Emelda Curry, Ivonne Rivera, Venton Jones, and Yanoh Jalloh for working diligently to conduct the interviews and focus groups. We would also like to thank the patients, investigators, staff, and study sites who participated in the qualitative substudy and the HPTN 065 Parent Study, under the Leadership of Drs. Wafaa M. El-Sadr and Bernard M. Branson (protocol members can be viewed at https://hptn.org/research/studies/77). The HIV Prevention Trials Network (HPTN) 065 Study is sponsored by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the National Institute on Drug Abuse, of the US National Institutes of Health, under Cooperative Agreements #UM1 AI 068619 and UM1 AI 068617, as well as the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, or the Centers for Disease Control and Prevention. We would like to thank the qualitative data collectors Abby Krumholz, Althea Anderson, Dionne Otey, Emelda Curry, Ivonne Rivera, Venton Jones, and Yanoh Jalloh for working diligently to conduct the interviews and focus groups. We would also like to thank the patients, investigators, staff, and study sites who participated in the qualitative substudy and the HPTN 065 Parent Study, under the Leadership of Drs. Wafaa M. El-Sadr and Bernard M. Branson (protocol members can be viewed at https://hptn.org/research/studies/77). Tolley, Taylor, Pack, Greene, Stanton, Shelus, Dunner, Hodge, Branson, El-Sadr and Gamble declares that they have no conflict of interest.
Keywords
- Adherence
- Financial incentives
- HIV
- Stage of change
- United States
ASJC Scopus subject areas
- Social Psychology
- Public Health, Environmental and Occupational Health
- Infectious Diseases
