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AIDS Care. 2017 Jul;29(7):876-884. doi: 10.1080/09540121.2017.1287340. Epub 2017 Apr 11.

It helps me live, sends my children to school, and feeds me: a qualitative study of how food and cash incentives may improve adherence to treatment and care among adults living with HIV in Tanzania.

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a School of Public Health, Division of Epidemiology , University of California , Berkeley , USA.
b Regional Medical Office, Ministry of Health, Community Development, Gender, Elderly, and Children , Shinyanga , Tanzania.
c The Sea Change Program , Berkeley , CA , USA.
d Prevention of Mother-to-Child HIV Transmission Programme, Ministry of Health, Community Development, Gender, Elderly, and Children , Dar es Salaam , Tanzania.


Financial and in-kind incentives have been shown to improve outcomes along the HIV care cascade, however the potential mechanismsthrough which they work remain unclear. To identify the pathways through which incentives improve retention in care and adherence to antiretroviral therapy (ART), we conducted a qualitative study with participants in a trial evaluating conditional food and cash incentives for HIV-positive food insecure adults in Shinyanga, Tanzania. We found that the incentives acted through three pathways to potentially increase retention in care and adherence to ART: (1) addressing competing needs and offsetting opportunity costs associated with clinic attendance, (2) alleviating stress associated with attending clinic and meeting basic needs, and (3) by potentially increasing motivation. Participants did not report any harmful events associated with the incentives, but reported myriad beneficial effects on household welfare. Understanding how incentives are used and how they impact outcomes can improve the design of future interventions.


ART adherence; HIV infection; Tanzania; cash transfers; food assistance; incentives; qualitative; retention

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