2023-09-28 14:46:10 +00:00
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abstract: 'Background
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Viral suppression among people living with HIV (PLHIV) is essential for
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protecting health and preventing HIV transmission, yet globally, rates
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of viral suppression are sub-optimal. Interventions to improve HIV
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prevention and care cascade outcomes remain vital. Financial incentives
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hold promise for improving these outcomes, yet to date, clinical trial
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results have been mixed.
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Methods
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This qualitative sub-study, embedded in a trial (NCT02890459) in Uganda
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to test whether incentives are effective for achieving viral suppression
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in PLHIV, sought to enhance our understanding of the factors that
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influence this outcome. Forty-nine (n = 49) PLHIV, purposely sampled to
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balance across gender, study arm, and viral suppression status, were
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interviewed to explore barriers and motivations for care engagement,
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adherence, and viral suppression, and attributions for decision-making,
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including perceived influence of incentives on behaviors.
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Results
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While many participants with undetectable viral load (VL) who received
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incentives said the incentives motivated their ART adherence, others
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expressed intrinsic motivation for adherence. All felt that incentives
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reduced burdens of transport costs, lost income due to time spent away
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from work, and food insecurity. Incentives may have activated attention
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and memory for some, as excitement about anticipating incentives helped
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them adhere to medication schedules. In comparison, participants who
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were randomized to receive incentives but had detectable VL faced a
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wider range, complexity and severity of challenges to care engagement.
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Notably, their narratives included more accounts of poor treatment in
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clinics, food insecurity, and severe forms of stigma. With or without
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incentives, adherence was reinforced through experiencing restored
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health due to ART, social support (especially from partners), and good
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quality counseling and clinical care.
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Conclusions
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In considering why incentives sometimes fail to achieve behavior change,
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it may be helpful to attend to the full set of factors- psychological,
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interpersonal, social and structural- that militate against the behavior
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change required to achieve behavioral outcomes. To be effective,
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incentives may need to be combined with other interventions to address
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the spectrum of barriers to care engagement.'
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affiliation: 'Camlin, CS (Corresponding Author), Univ Calif San Francisco, Dept Obstet
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Gynecol \& Reprod Sci, San Francisco, CA 94115 USA.
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Camlin, Carol S.; Getahun, Monica, Univ Calif San Francisco, Dept Obstet Gynecol
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\& Reprod Sci, San Francisco, CA 94115 USA.
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Marson, Kara; Emperador, Devy; Chamie, Gabriel, Univ Calif San Francisco, Dept Med,
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San Francisco, CA 94143 USA.
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Ndyabakira, Alex; Byamukama, Ambrose; Kwarisiima, Dalsone, Infect Dis Res Collaborat,
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Kampala, Uganda.
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Thirumurthy, Harsha, Univ Penn, Perelman Sch Med, Philadelphia, PA USA.'
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article-number: e0270180
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author: Camlin, Carol S. and Marson, Kara and Ndyabakira, Alex and Getahun, Monica
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and Emperador, Devy and Byamukama, Ambrose and Kwarisiima, Dalsone and Thirumurthy,
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Harsha and Chamie, Gabriel
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author-email: carol.camlin@ucsf.edu
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author_list:
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- family: Camlin
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given: Carol S.
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- family: Marson
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given: Kara
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- family: Ndyabakira
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given: Alex
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- family: Getahun
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given: Monica
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- family: Emperador
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given: Devy
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- family: Byamukama
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given: Ambrose
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- family: Kwarisiima
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given: Dalsone
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- family: Thirumurthy
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given: Harsha
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- family: Chamie
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given: Gabriel
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da: '2023-09-28'
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doi: 10.1371/journal.pone.0270180
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files: []
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issn: 1932-6203
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journal: PLOS ONE
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keywords-plus: 'CONDITIONAL CASH TRANSFERS; ANTIRETROVIRAL THERAPY; CARE; ADULTS;
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RETENTION; ADHERENCE; LINKAGE'
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language: English
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month: JUN 30
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number: '6'
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number-of-cited-references: '23'
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orcid-numbers: Camlin, Carol/0000-0001-5615-1164
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papis_id: 47227869c615888cef8d3e0f5393d551
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ref: Camlin2022understandingrole
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times-cited: '0'
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title: 'Understanding the role of incentives for achieving and sustaining viral suppression:
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A qualitative sub-study of a financial incentives trial in Uganda'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000892027900066
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usage-count-last-180-days: '0'
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usage-count-since-2013: '1'
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volume: '17'
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web-of-science-categories: Multidisciplinary Sciences
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year: '2022'
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