Many people living with HIV in Sub Sahara Africa failed to adhere to free Anti-retroviral Therapy (ART), the medical treatment for HIV that can stop the virus from progressing and transmitting. This paper seeks to identify the barriers to treatment adherence. We recruit patients that are new on ART from a large health center in Mozambique and randomly provide interventions to assist them in overcoming the limited attention problem, information imperfection, or social stigma concerns. We track the medication possession ratio (MPR) in six months to evaluate the interventions and benchmark their effects against conditional cash transfers. Moreover, to shed light on the spillovers of the interventions, we offer coupons for the participants to refer their partners to get tested. The experiment result will inform us of behavioral patterns of the population that are economically and physically vulnerable. Effective interventions are ready to be scaled up in HIV-treatment facilities in resource-constrained environments.
Partners: UM Econ (MITRE, Jordan Dickstein and Kim Dickstein Research Award), ISR (director), PSC (PDHP), UM African Study Center, UM Medical school (global Reach), UM Rackham Graduate School (International Research Award), Lessitala, CIOB, CNBS
A pre-analysis plan for this project was submitted to the American Economic Association's RCT Registry on September 10, 2018 (AEARCTR-0003184).
Below you can find the pre-anlaysis plan that was submitted.
IRB number: HUM00133179 IRBMed
Participants were enrolled in one of six different study groups (five treatment and one control):
- Financial Incentives - Participants were paid 200 MTS (about US$2.6) each time they refilled their ART medication on time (on or before their monthly refill date).
- Reminders - Participants received a phone call reminding them to refill their ART medication 3 days before each monthly refill date.
- Combination - Participants received both the financial incentive and reminder treatments. In the reminder phone call, they were reminded of both the coming refill date and the associated financial incentive conditional on refilling on time.
- Information - During the recruitment survey, participants were shown a short video explaining the risks of HIV and the benefits of proper adherence to ART. [The video (in Portuguese) can be viewed here, and the text content can be found here.]
- Stigma Alleviation - Our study had previously collected data on HIV stigma levels in nearby communities. If the patient overestimates the extent of stigma, we inform them of the results of the survey (i.e. we tell them that stigma is lower than they believe). [The exact protocols can be found here.]
- Control - Participants received no intervention.
HIV and ART Videos
HIV/AIDS and ART Information Video