Trial reportBMJ global health2026
How do repeated financial incentives affect HIV care-seeking behaviours over time? Evidence from a cluster-randomised controlled trial.
Trial report in BMJ global health, 2026. 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. Not yet cited in PubMed.
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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.
The trial behind it
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Optimizing the Efficiency and Implementation of Cash Transfers to Improve Adherence to Antiretroviral Therapy, Phase II: Effectiveness Study
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Authors and funding
10 authors.
Funding
Abstract
backgroundA more nuanced understanding of behavioural responses to incentives over time, particularly after they are removed, could guide more effective interventions. In this study, we build on the primary trial evaluation to explore the dynamic effectiveness of small, short-term monthly financial incentives on HIV care-seeking behaviours during and after incentive removal.
methodsWe conducted a 32-site cluster-randomised controlled trial (NCT04201353) among adult antiretroviral therapy (ART) initiates (<30 days) in four regions of Lake Zone, Tanzania. HIV care and treatment clinics were randomly assigned 1:1 to the intervention (up to 6 monthly cash transfers of 22 500 TZS each (~US$10), conditional on appointment attendance) or standard of care. Using time-to-event analysis, we assess the effect of incentives on three HIV-care seeking behaviours: missed appointment by >4 days, <90% ART adherence and interruption in treatment of >28 days.
resultsAmong 1990 participants, we found large significant reductions in rate of missed appointments (hazard ratio (HR), 95% CI: 0.51, 0.39 to 0.68), <90% ART adherence (HR, 95% CI: 0.58, 0.41 to 0.83) and interruption in treatment (>28 days without ART) (HR, 95% CI: 0.54, 0.35 to 0.83) during the 6 months of incentives, but no effects after their removal. HRs by month reveal similar findings, with dramatic and consistent reductions in risk concentrated in months 2-6 that disappear in month 7, immediately after incentives are discontinued.
conclusionsThese results highlight the value of short-term incentives for initiating new care-seeking behaviours and emphasise a need for innovative design choices, such as escalating rewards or incorporation of time- or context-based cues, that may help motivate sustained behaviour change after their removal. TRIAL REGISTRATION NUMBER: NCT04201353.
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