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How do repeated financial incentives affect HIV care-seeking behaviours over time? Evidence from a cluster-randomised
Solis Winters1,2, Emmanuel Katabaro3, Babuu Joseph3
1Health Studies, University of Richmond, Richmond, Virginia, USA solis.winters@richmond.edu.
BMJ Global Health
|February 17, 2026
Summary
Short-term financial incentives significantly improved HIV care-seeking behaviors like appointment attendance and ART adherence during the intervention period. However, these positive effects on HIV treatment adherence disappeared immediately after the incentives were removed.
Area of Science:
- Public Health
- Behavioral Economics
- HIV/AIDS Research
Background:
- Understanding long-term behavioral responses to incentives is crucial for designing effective public health interventions.
- This study investigates the dynamic impact of short-term financial incentives on HIV care-seeking behaviors during and after incentive withdrawal.
Purpose of the Study:
- To evaluate the effectiveness of monthly financial incentives on HIV care-seeking behaviors.
- To assess the sustainability of behavior change after incentive removal.
Main Methods:
- A cluster-randomised controlled trial involving 32 sites in Tanzania.
- Adults initiating antiretroviral therapy (ART) received up to 6 monthly cash transfers conditional on appointment attendance.
- Time-to-event analysis was used to assess missed appointments, ART adherence (<90%), and treatment interruption (>28 days).
Main Results:
- Significant reductions were observed in missed appointments (HR: 0.51), <90% ART adherence (HR: 0.58), and treatment interruption (HR: 0.54) during the 6-month incentive period.
- These positive effects on HIV care-seeking behaviors diminished immediately after incentives were discontinued.
- Reductions in risk were concentrated between months 2 and 6, disappearing in month 7.
Conclusions:
- Short-term financial incentives can effectively initiate new care-seeking behaviors in HIV patients.
- Sustaining behavior change after incentive removal requires innovative strategies, such as escalating rewards or context-based cues.
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