Adolescent and young adult preferences for financial incentives to support adherence to antiretroviral therapy in Kenya: a mixed methods study

Abstract

Introduction To develop a patient‐centred financial incentive delivery strategy to improve antiretroviral treatment adherence in adolescents and young adults (AYA) living with HIV in Kisumu, Kenya, we conducted a mixed methods study exploring preferences. Methods A discrete choice experiment (DCE) and focus group discussion (FGD) were conducted simultaneously to identify preferences for five incentive delivery strategy features: value, eligibility, recipient, format and disbursement frequency. We used consecutive sampling to recruit AYA (14–24 years) living with HIV attending three health facilities in Kisumu, Kenya. We calculated mean preferences, willingness to trade, latent class membership and predictors of latent class membership. The FGD explored preferred incentive features, and, after deductive and inductive coding, qualitative findings were triangulated with DCE results. Results Two hundred and seven AYA living with HIV (46% 14–17 years, 54% 18–24 years; 33% male sex, 89% viral load <50 copies/ml) were recruited to the study (28 October–16 November 2020). Two distinct preference phenotypes emerged from the DCE analysis (N = 199), 44.8% of the population fell into an “immediate reward” group, who wanted higher value cash or mobile money distributed at each clinic visit, and 55.2% fell into a “moderate spender” group, who were willing to accept lower value incentives in the form of cash or shopping vouchers, and accrued payments. The immediate reward group were willing to trade up to 200 Kenyan Shillings (KSH)—approximately 2 US dollars (USD)—of their 500 KSH (∼5 USD) incentive to get monthly as opposed to accrued yearly payments. The strongest predictor of latent class membership was age (RR 1.45; 95% CI: 1.08–1.95; p = 0.006). Qualitative data highlighted the unique needs of those attending boarding school and confirmed an overwhelming preference for cash incentives which appeared to provide the greatest versatility for use. Conclusions Providing small financial incentives as cash was well‐aligned with AYA preferences in this setting. AYA should additionally be offered a choice of other incentive delivery features (such as mobile money, recipient and disbursement frequency) to optimally align with the specific needs of their age group and life stage.

HIV Care Preferences among Young People Living with HIV in Lesotho: A Secondary Data Analysis of the PEBRA Cluster Randomized Trial

“…Regarding preference data among young people living with HIV in sub-Saharan Africa, studies and discrete choice experiments on HIV testing [19], pre-exposure prophylaxis [20,21], and fnancial incentives [22] exist but none assessing general care preferences. In a formative study about the engagement of young people in sexual and reproductive health, there was great interest in accessing health services at community hubs rather than the health facilities [23].…”

Adapt for Adolescents: Protocol for a Sequential Multiple Assignment Randomized Trial to Improve Retention and Viral Suppression Among Adolescents and Young Adults Living with HIV in Kenya

“…Formative study results contributed to intervention design decisions, for example, selection of acceptable wording for text messages, importance of including AYAH without phone access, amount and method of incentive delivery (Kenya Shilling 500 =~US $5), and training of peer navigators in how to address anticipated social support needs. (26) Additionally, formative work, as well as experience delivering CCT for adults in Kenya, informed the incentive amount to ensure it is not coercive and limited the number of disbursements to reduce intentional lapses.…”