Small 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. In 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 , , and is completed. Between 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. Short-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. National Institute of Mental Health. For the Swahili translation of the abstract see Supplementary Materials section.

中文翻译：

---

经济激励对坦桑尼亚开始 HIV 治疗的成年人病毒抑制的影响：一项混合有效性实施试验


小额激励措施可以提高 HIV 护理的参与度。我们评估了在坦桑尼亚开始抗逆转录病毒治疗 （ART） 的成年人中就诊的经济激励对病毒抑制的短期和长期影响。在一项 1 型混合有效性实施研究中，我们将 （1：1） 坦桑尼亚四个地区的 32 家初级保健 HIV 诊所随机分配到常规护理（对照组）或干预组（常规护理加 ≤6 个月奖励 [22 500 坦桑尼亚先令，每个约 10 美元]，以就诊为条件）。开始 ART 的成年人 （≥18 岁） （x3C30 天） 拥有手机且没有转移到其他机构的计划，符合条件。主要结局是 12 个月时病毒抑制 ART 的保留率 （<1000 拷贝/mL）。次要结局包括在 6 个月时病毒抑制 ART 的保留率，以及使用较低阈值 （<50 拷贝/mL） 在 6 个月和 12 个月时病毒抑制。意向治疗分析和基于集群的排列检验用于评估经济激励对结果的影响。此试用版已向 、 注册并完成。在 2021 年 5 月 28 日至 2022 年 3 月 8 日期间，1990 名参与者（805 名男性和 1185 名女性）参加了该研究。1059 名参与者被分配到干预组，931 名参与者被分配到对照组。总体而言，1536 名 （88%） 参与者在 6 个月时和 1575 名 （83%） 在 12 个月时接受了病毒抑制 ART。干预结束后 12 个月 6 个月，干预组有 866 名 （85%） 参与者与对照组 709 名 （81%） 参与者的病毒载量低于每毫升 1000 个拷贝（调整后的风险差 [aRD] 4·4 个百分点，95% CI -1·4 至 10·1，排列测试 p=0·35）。 在 6 个月时，干预组有 858 名参与者 （90%） 接受 ART，病毒载量低于 1000 拷贝/mL，而对照组为 678 名 （86%） （aRD 5·1 个百分点，95% CI 1·1 至 9·1，排列测试 p=0·06）。病毒抑制阈值较低，6 个月和 12 个月的影响更大，并且不同地区存在显着的效果异质性。不良事件包括 106 例死亡 （对照组 56 例，干预组 50 例），均与研究参与无关。就诊的短期激励对病毒抑制有适度的短期益处，并且不会损害停药后的保留或病毒抑制。这些发现表明需要了解谁最能从支持 HIV 护理的激励措施中受益。国家心理健康研究所。有关摘要的斯瓦希里语翻译，请参阅补充材料部分。