Suchergebnisse

BACKGROUND: Viral suppression among HIV-positive individuals is essential for protecting health and preventing HIV transmission. Financial incentives have shown promise in modifying various health behaviors in low-income countries but few studies have assessed whether they can improve HIV treatment outcomes. We aimed to determine the impact of time-limited financial incentives on viral suppression among HIV-positive adults in rural Uganda. METHODS: We conducted a randomized trial in four rural Ugandan parishes between June 27, 2016 and May 25, 2018. HIV-positive individuals aged ≥18 years were recruited from community health campaigns that included HIV testing services or at a local government health facility where HIV treatment is offered. Participants included those who were initiating antiretroviral therapy (ART) or already receiving ART. We measured participants' viral load at baseline, 6, 12, 24, and 48 weeks and provided results along with viral load counseling. Participants randomized to the intervention group received financial incentives for viral suppression at 6, 12, and 24 weeks, with incentive amounts escalating from US$4 to US$12.5. The primary outcome was viral suppression (viral load<400 copies per mL) at 24 weeks. To assess longerterm effects of time-limited incentives, the secondary outcome was viral suppression at 48 weeks. This trial is registered with ClinicalTrials.gov (NCT02890459). FINDINGS: 400 adults were enrolled in the study, 324 from community health campaigns and 76 from the government clinic. Of these, eight (2%) withdrew from the study and were not included in analyses. Over the 48-week follow-up period, 35 (9%) died or were lost-to-follow-up. Participants' median daily income was US$0.79. At baseline, 300 participants (77%) were virally suppressed. In intention-to-treat analyses, 168 participants (84%) in the intervention group and 156 participants (82%) in the control group were virally suppressed at 24 weeks (odds ratio, OR, 1.14, 95% CI 0.68–1.93, p=0.62. In per-protocol ...