# Strengthening the continuity of HIV care in Tanzania with economic support

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA BERKELEY · 2022 · $642,478

## Abstract

SUMMARY
It is increasingly recognized that global goals for HIV epidemic control cannot be realized without improving
retention in HIV care and adherence to antiretroviral therapy (ART). Only 58% of people living with HIV
(PLHIV) in eastern and southern Africa are virally suppressed, and adherence counseling provided to those
with elevated viral loads results in viral suppression only 40-50% of the time. Financial incentives, first used for
poverty reduction, have been shown to motivate behavior change and improve engagement in HIV-related
services. However, there is a paucity of data about the effectiveness of incentive-based programs for people
who have disengaged from HIV care as well as the proactive use of incentives for PLHIV struggling with
adherence. This research gap limits our understanding of whether financial incentive programs are worthwhile
investments to support lifelong care, which is essential to the success of ‘treatment as HIV prevention’ (TasP).
The proposed research will advance global knowledge about the effectiveness of financial incentives for
strengthening the continuity of HIV care. We will build on data from a pilot study we conducted in Tanzania
which found that an intervention offering a one-time financial incentive to out-of-care PLHIV was feasible,
acceptable, and preliminarily efficacious at motivating re-engagement in HIV care. Leveraging our established
research program and expertise with behavioral economics, we designed a 5-year, mixed-methods, hybrid
effectiveness-implementation study to evaluate the financial incentive intervention and describe its successful
implementation, with the ultimate goal of closing the gap towards achievement of UNAIDS’ ‘95-95-95’ goals. We
will first assess if a one-time financial incentive improves re-engagement in care and durable viral suppression
at 12 months among 640 PLHIV in Geita and Kagera Regions who have disengaged from care (Aim 1). We
will then measure the effectiveness of short-term financial incentives offered to 692 in-care PLHIV who are at
risk of loss to follow-up or poor adherence, with durable viral suppression at 12 months as the outcome (Aim
2). A mixed-methods study will describe implementation successes and challenges and synthesize lessons
learned to inform adoption of incentive programs for vulnerable PLHIV (Aim 3). The project is a collaboration of
the University of California, Berkeley, Health for a Prosperous Nation, Rasello, Management and Development
for Health, and the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children.
At the conclusion of the project, we will have rigorously evaluated the incentive strategy and will understand
whether it can mitigate the persistent challenge of disengagement from HIV care, consistent with NIH Office of
AIDS Research priorities for implementation research on retention in care and adherence to ART. This
information is highly relevant to the spectrum of incentive-based programs being imp...

## Key facts

- **NIH application ID:** 10463589
- **Project number:** 5R01MH125746-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA BERKELEY
- **Principal Investigator:** Sandra I McCoy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $642,478
- **Award type:** 5
- **Project period:** 2021-08-15 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10463589

## Citation

> US National Institutes of Health, RePORTER application 10463589, Strengthening the continuity of HIV care in Tanzania with economic support (5R01MH125746-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10463589. Licensed CC0.

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