Financial Incentives to Improve Re-engagement in HIV Care: Results from a Randomized Pilot Study


Objective: Determine the feasibility, acceptability, and preliminary effectiveness of financial incentives to motivate re-engagement in HIV care in Shinyanga, Tanzania.

Design: Randomized controlled trial.

Methods: People living with HIV (PLHIV) who were disengaged from care were located by home-based care providers (HBCs). Eligible PLHIV were: Shinyanga Region residents, >18 years of age, and disengaged from HIV care. Participants were randomized 1:1 to a financial incentive (~10 USD) or the standard of care (SOC), stratified by site. Primary outcomes were feasibility (located PLHIV who agreed to discuss the study), acceptability (enrollment among eligibles), and re-engagement in care (clinic visit within 90 days).

Results: HBCs located 469 (35.8%) of 1,309 out-of-care PLHIV. Of these, 215 (45.8%) were preliminarily determined to be disengaged from care, 201 (93.5%) agreed to discuss the study, and 157 eligible (100%) enrolled. Overall, 71 (85.5%) PLHIV in the incentive arm re-engaged in care within 90 days vs. 58 (78.4%) in the SOC (Risk difference [RD] = 0.07, 95% CI: -0.05, 0.19, p=0.24; Adjusted RD [ARD] = 0.08, 95% CI: -0.03, 0.19, p=0.09). A higher proportion of incentivized PLHIV completed an additional (unincentivized) visit between 90-180 days (79.5% vs. 71.6%, ARD = 0.10,  95% CI: -0.03, 0.24, p=0.13) and were in care at 180 days (57.8% vs. 51.4%, ARD = 0.07, CI: -0.09, 0.22, p =0.40).

Conclusions: Short-term financial incentives are an acceptable and feasible strategy for re-engagement in HIV care. Incentivized PLHIV had non-significantly higher re-engagement and retention compared to non-incentivized peers, warranting further study of this approach.