Effectiveness of Non-Cash Incentives and Psychosocial Support on Six-Months Retention on Treatment among People Living with HIV/AIDS in Kibera Informal Settlement, Nairobi, Kenya

Abstract

This study sought to determine the effectiveness of non-cash incentives combined with psychosocial support on retention during the first six months of HIV treatment among patients in informal settlement of Kibera in Nairobi, Kenya. The non-cash incentive consisted of a reminder at every clinic visit that the participants stand to receive free T-shirts of their favorite football team or free Kiondos based on preference if they made it to the sixth month visit without missing a treatment appointment. The study adopted an experimental design conducted at three study sites of Kibera Community Health Center, Kibera South Health Center and Silanga Dispensary, within Kibera informal settlement, where participants were randomly assigned to the intervention and control groups at a ratio of 1:1. Participants in the intervention group received a reminder at every clinic visit that they stand to receive the non-cash incentive if they made it to the sixth month visit without missing treatment appointment and attending all monthly psychosocial support group meetings. Participants in both intervention and control groups received the standard care. A total of 388 participants were recruited into the study and followed up for an average period of six months. The overall retention on treatment at six months was 93% (95% CI: 90 - 95%). Retention at six months among the intervention and control groups were 94% and 91% respectively (aRR: 1.03; 95% CI: 0.98 - 1.09; p-value=0.24). Predictors of patients’ retention on treatment were being divorced, being widowed, time to clinic, participant weight category of 70-99 kg, being on 1st line regimen of TDF/3TC/EFV and other 1st line ART regimens which included ABC/3TC/EFV+AZT/3TC/LPV/r+AZT/3TC/NVP +D4T/3TC/EFV+TDF/3TC/NVP. Mortality and lost to follow-up rates were 1.6 and 13.5 per 100 person-years, respectively. The combination of non-cash incentives and psychosocial support was not effective in improving retention during the first six months of HIV/AIDS treatment. The study provided an important contribution to understanding the potential of non-cash incentives combined with psychosocial support to achieving epidemic control in resource limited settings. Further research investigating the long-term effects, cost-effectiveness, scalability and sustainability of such interventions are warranted.