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  • July 31, 2017
  • Article
  • AIDS

A Commitment Contract to Achieve Virologic Suppression in Poorly Adherent Patients with HIV/AIDS

By: Marcella Alsan, John Beshears, Wendy S. Armstrong, James J. Choi, Brigitte C. Madrian, Minh Ly T. Nguyen, Carlos Del Rio, David Laibson and Vincent C. Marconi
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Abstract

Objective: Assess whether a commitment contract informed by behavioral economics leads to persistent virologic suppression among HIV-positive patients with poor antiretroviral therapy (ART) adherence. Design: Single-center pilot randomized clinical trial and a nonrandomized control group. Setting: Publicly funded HIV clinic in Atlanta, Georgia, USA. Intervention: The study involved three arms. First, participants in the provider visit incentive (PVI) arm received $30 after attending each scheduled provider visit. Second, participants in the incentive choice arm were given a choice between the above arrangement and a commitment contract that made the $30 payment conditional on both attending the provider visit and meeting an ART adherence threshold. Third, the passive control arm received routine care and no incentives. Participants: A total of 110 HIV-infected adults with a recent plasma HIV-1 viral load more than 200 copies/ml despite ART. The sample sizes of the three groups were as follows: PVI, n=21; incentive choice, n=19; and passive control, n=70. Main outcome measure: Virologic suppression (plasma HIV-1 viral load<=200 copies/ml) at the end of the incentive period and at an unanticipated postincentive study visit approximately three months later. Results: The odds of suppression were higher in the incentive choice arm than in the passive control arm at the postincentive visit (adjusted odds ratio 3.93, 95% confidence interval 1.19–13.04, P=0.025). The differences relative to the passive control arm at the end of the incentive period and relative to the PVI arm at both points in time were not statistically significant. Conclusion: Commitment contracts can improve ART adherence and virologic suppression.

Keywords

Adherence; Antiretroviral Therapy; Behavioral Economics; Commitment Contract; Financial Incentives; HIV-1 Virologic Suppression; Health Disorders; Motivation and Incentives

Citation

Alsan, Marcella, John Beshears, Wendy S. Armstrong, James J. Choi, Brigitte C. Madrian, Minh Ly T. Nguyen, Carlos Del Rio, David Laibson, and Vincent C. Marconi. "A Commitment Contract to Achieve Virologic Suppression in Poorly Adherent Patients with HIV/AIDS." AIDS 31, no. 12 (July 31, 2017): 1765–1769.
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About The Author

John Beshears

Negotiation, Organizations & Markets
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  • Optimal Illiquidity By: John Beshears, James J. Choi, Christopher Clayton, Christopher Harris, David Laibson and Brigitte C. Madrian
  • Automatic Enrollment with a 12% Default Contribution Rate By: John Beshears, Ruofei Guo, David Laibson, Brigitte C. Madrian and James J. Choi
  • Smaller than We Thought? The Effect of Automatic Savings Policies By: James J. Choi, David Laibson, Jordan Cammarota, Richard Lombardo and John Beshears
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