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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
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.
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.
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