Evidence map›Paper›PMID 39098325›Full record

Trial reportThe lancet. HIV2024

Impact of financial incentives on viral suppression among adults initiating HIV treatment in Tanzania: a hybrid effectiveness-implementation trial.

Prosper F Njau, Emmanuel Katabaro, Solis Winters, Amon Sabasaba, Kassim Hassan, Babuu Joseph, Hamza Maila, Janeth Msasa, Carolyn A Fahey, Laura Packel and 5 more

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The lancet. HIV, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04201353 (Optimizing the Efficiency and Implementation of Cash Transfers to Improve Adherence to Antiretroviral Therapy, Phase II), which is not on this map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04201353 nacompletednot on this map

Optimizing the Efficiency and Implementation of Cash Transfers to Improve Adherence to Antiretroviral Therapy, Phase II: Effectiveness Study

TypeinterventionalSponsorUniversity of California, BerkeleyRan2020 to 2024Enrolled1,984ConditionsHIV (Human Immunodeficiency Virus)ArmsConditional Cash Transfer
3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Article
  6. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

15 authors.

Prosper F NjauNational AIDS, STIs and Hepatitis Control Programme, Ministry of Health, Dodoma, Tanzania.
Emmanuel KatabaroHealth for a Prosperous Nation, Dar es Salaam, Tanzania.
Solis WintersSchool of Public Health, University of California, Berkeley, CA, USA.
Amon SabasabaHealth for a Prosperous Nation, Dar es Salaam, Tanzania.
Kassim HassanHealth for a Prosperous Nation, Dar es Salaam, Tanzania.
Babuu JosephHealth for a Prosperous Nation, Dar es Salaam, Tanzania.
Hamza MailaHealth for a Prosperous Nation, Dar es Salaam, Tanzania.
Janeth MsasaHealth for a Prosperous Nation, Dar es Salaam, Tanzania.
Carolyn A FaheySchool of Public Health, University of California, Berkeley, CA, USA; School of Public Health, University of Washington, Seattle, WA, USA.
Laura PackelSchool of Public Health, University of California, Berkeley, CA, USA.
William H DowSchool of Public Health, University of California, Berkeley, CA, USA.
Nicholas P JewellSchool of Public Health, University of California, Berkeley, CA, USA; London School of Hygiene & Tropical Medicine, London, UK.
Nzovu UlengaManagement and Development for Health, Dar es Salaam, Tanzania.
Natalino MwendaRasello, Dar es Salaam, Tanzania.
Sandra I McCoySchool of Public Health, University of California, Berkeley, CA, USA. Electronic address: smccoy@berkeley.edu.

Funding

University of Washington/Fred Hutch Center for AIDS ResearchP30AI027757 · NIAID · UNIVERSITY OF WASHINGTON · PI CONNIE L CELUM · 1988 to 2026
$104.9M
Research Mentoring and Building Capacity of underrepresented Minority Research Scientists in India.D43TW010540 · FIC · YALE UNIVERSITY · PI MICHELE BARRY, Eva Harris · 2017 to 2026
$15.5M
Optimizing the efficiency and implementation of cash transfers to improve adherenceto antiretroviral therapyR01MH112432 · NIMH · UNIVERSITY OF CALIFORNIA BERKELEY · PI MCCOY, SANDRA I · 2017 to 2021
$2.9M
Emerging methods and applications for test-negative studies of of infectious disease interventionsR01AI148127 · NIAID · UNIVERSITY OF CALIFORNIA BERKELEY · PI JEWELL, NICHOLAS P · 2020 to 2023
$1.8M
FIC NIH HHS D43 TW010540NIAID NIH HHS P30 AI027757NIAID NIH HHS R01 AI148127NIMH NIH HHS R01 MH112432
6 · The paper itself

Abstract

backgroundSmall incentives could improve engagement in HIV care. We evaluated the short-term and longer-term effects of financial incentives for visit attendance on viral suppression among adults initiating antiretroviral therapy (ART) in Tanzania.

methodsIn a type 1 hybrid effectiveness-implementation study, we randomised (1:1) 32 primary care HIV clinics in four Tanzanian regions to usual care (control group) or the intervention (usual care plus ≤6 monthly incentives [22 500 Tanzanian Shillings, about US$10, each], conditional on visit attendance). Adults (aged ≥18 years) initiating ART (<30 days) who owned a mobile phone and had no plans to transfer to another facility were eligible. The primary outcome was retention on ART with viral suppression (<1000 copies per mL) at 12 months. Secondary outcomes included retention on ART with viral suppression at 6 months and viral suppression at 6 months and 12 months using a lower threshold (<50 copies per mL). Intent-to-treat analysis and a cluster-based permutation test were used to evaluate the effect of financial incentives on outcomes. This trial is registered with ClinicalTrials.gov, NCT04201353, and is completed.

findingsBetween May 28, 2021, and March 8, 2022, 1990 participants (805 male and 1185 female) were enrolled in the study. 1059 participants were assigned to the intervention group and 931 participants were assigned to the control group. Overall, 1536 (88%) participants at 6 months and 1575 (83%) at 12 months were on ART with viral suppression. At 12 months, 6 months after the intervention ended, 866 (85%) participants in the intervention group compared with 709 (81%) in the control group had viral loads less than 1000 copies per mL (adjusted risk difference [aRD] 4·4 percentage points, 95% CI -1·4 to 10·1, permutation test p=0·35). At 6 months, 858 participants (90%) in the intervention group were on ART with viral loads less than 1000 copies per mL compared with 678 (86%) in the control group (aRD 5·1 percentage points, 95% CI 1·1 to 9·1, permutation test p=0·06). Effects were larger at 6 months and 12 months with the lower threshold for viral suppression, and there was significant effect heterogeneity by region. Adverse events included 106 deaths (56 in the control group and 50 in the intervention group), none related to study participation.

interpretationShort-term incentives for visit attendance had modest, short term benefits on viral suppression and did not harm retention or viral suppression after discontinuation. These findings suggest the need to understand subgroups who would most benefit from incentives to support HIV care.

fundingNational Institute of Mental Health. TRANSLATION: For the Swahili translation of the abstract see Supplementary Materials section.

Indexed as

Anti-HIV AgentsHIV InfectionsMotivationViral LoadAdultFemaleHumansMaleMiddle AgedSustained Virologic ResponseTanzaniaTreatment OutcomeYoung AdultAnti-HIV Agents

Identifiers

PMID39098325
PMCPMC11457171

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.