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Combining Behavioral Endocrinology and Experimental Economics: Testosterone and Social Decision Making
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Published on: March 2, 2011

Identity-Based Behavioral Economic Incentives Increased PrEP Adherence for Transgender and Nonbinary Adults in a

Kimberly Ling Murtaugh1,2, Alex R Dopp3, Carrie L Nacht4,5

  • 1Department of Public Policy, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, USA.

AIDS and Behavior
|July 14, 2026
PubMed
Summary

Identity-based incentives boosted PrEP adherence in transgender and nonbinary adults. This pilot study found incentives feasible, acceptable, and cost-effective for improving HIV prevention among this high-risk group.

Keywords:
Behavioral EconomicsHIV PreventionHealth equityIdentity EconomicsPrEPTransgender community

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Area of Science:

  • Public Health
  • Behavioral Economics
  • HIV Prevention

Background:

  • Transgender and nonbinary (TGNB) adults face significant barriers to PrEP engagement, leading to disproportionately high HIV rates.
  • Existing PrEP programs require tailored strategies to address structural and economic challenges, especially for TGNB individuals of color.

Purpose of the Study:

  • To pilot the integration of identity-based behavioral economic incentives into a community-led PrEP navigation program (PrEP Well).
  • To assess the acceptability, feasibility, and preliminary effects of these incentives on PrEP adherence among TGNB adults.

Main Methods:

  • A non-randomized pilot trial involving 108 TGNB adults at a TGNB-led community center.
  • Incorporated identity-affirming prizes selected by the TGNB community and earned through PrEP-related activities.
  • Compared outcomes before and after incentive implementation.

Main Results:

  • The addition of incentives was feasible and acceptable, significantly increasing PrEP adherence at 90 days (78.6% vs. 56.3%, p < .05).
  • Each additional incentive spin increased the odds of 90-day PrEP adherence by approximately 4.7-fold (p < .001).
  • The intervention had a modest additional cost of approximately $51 per participant.

Conclusions:

  • Integrating identity-based behavioral economic incentives into community-based services is a promising, cost-effective strategy.
  • This approach can enhance PrEP engagement and improve HIV prevention outcomes for TGNB adults.
  • Tailored, identity-affirming interventions are crucial for addressing health disparities in TGNB communities.