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A commitment contract to achieve virologic suppression in poorly adherent patients with HIV/AIDS.

A commitment contract to achieve virologic suppression in poorly adherent patients with HIV/AIDS.
Author Information (click to view)

Alsan M, Beshears J, Armstrong WS, Choi JJ, Madrian BC, Nguyen MLT, Del Rio C, Laibson D, Marconi VC,


Alsan M, Beshears J, Armstrong WS, Choi JJ, Madrian BC, Nguyen MLT, Del Rio C, Laibson D, Marconi VC, (click to view)

Alsan M, Beshears J, Armstrong WS, Choi JJ, Madrian BC, Nguyen MLT, Del Rio C, Laibson D, Marconi VC,

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AIDS (London, England) 31(12) 1765-1769 doi 10.1097/QAD.0000000000001543

Abstract
OBJECTIVE
Assess whether a commitment contract informed by behavioral economics leads to persistent virologic suppression among HIV-positive patients with poor antiretroviral therapy (ART) adherence.

DESIGN
Single-center pilot randomized clinical trial and a nonrandomized control group.

SETTING
Publicly funded HIV clinic in Atlanta, Georgia, USA.

INTERVENTION
The study involved three arms. First, participants in the provider visit incentive (PVI) arm received $30 after attending each scheduled provider visit. Second, participants in the incentive choice arm were given a choice between the above arrangement and a commitment contract that made the $30 payment conditional on both attending the provider visit and meeting an ART adherence threshold. Third, the passive control arm received routine care and no incentives.

PARTICIPANTS
A total of 110 HIV-infected adults with a recent plasma HIV-1 viral load more than 200 copies/ml despite ART. The sample sizes of the three groups were as follows: PVI, n = 21; incentive choice, n = 19; and passive control, n = 70.

MAIN OUTCOME MEASURE
Virologic suppression (plasma HIV-1 viral load ≤200 copies/ml) at the end of the incentive period and at an unanticipated postincentive study visit approximately 3 months later.

RESULTS
The odds of suppression were higher in the incentive choice arm than in the passive control arm at the postincentive visit (adjusted odds ratio 3.93, 95% confidence interval 1.19-13.04, P = 0.025). The differences relative to the passive control arm at the end of the incentive period and relative to the PVI arm at both points in time were not statistically significant.

CONCLUSION
Commitment contracts can improve ART adherence and virologic suppression.

TRIAL REGISTRATION
ClinicalTrials.gov identifier NCT01455740.

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