Participant perspectives on incentives for TB preventative therapy adherence and reduced alcohol use: A qualitative study

Economic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants’ experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers’ Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy. We interviewed 32 DIPT study participants across trial arms to explore their perspectives on this intervention. Participants described 1) satisfaction with incentives of sufficient size that allowed them to purchase items that improved their quality of life, 2) multiple ways in which incentives were motivating, from gamification of “winning” through support of pre-existing desire to improve health to suggesting variable effects of extrinsic and intrinsic motivation, and 3) finding value in learning results of increased clinical monitoring. To build effective incentive programs to support both reduced substance use and increased antimicrobial adherence, we recommend carefully selecting incentive magnitude as well as harnessing both intrinsic motivation to improve health and extrinsic reward of target behavior. In addition to these participant-described strengths, incorporating results of clinical monitoring related to the incentive program that provide participants more information about their health may also contribute to health-related empowerment.

促进健康行为改变的经济激励措施对物质使用障碍以及提高药物依从性非常有效。为了了解激励措施的作用机制并优化未来基于激励的干预措施，需要了解参与者对激励措施的体验和看法。预防结核病饮酒者干预（DIPT）试验在乌干达招募了患有潜伏性结核病且饮酒不健康的艾滋病毒感染者（PWH），进行了一项2×2析因试验，该试验在异烟肼预防性治疗期间，根据每月的尿液检测结果，对近期戒酒和异烟肼（INH）依从性进行激励。我们采访了试验各分组的32名DIPT研究参与者，以探讨他们对该干预措施的看法。参与者描述了以下几点：1）对足够金额的激励措施感到满意，这些激励措施使他们能够购买改善生活质量的物品；2）激励措施具有多种激励方式，从“获胜”的游戏化，到支持先前存在的改善健康的愿望，再到表明外在和内在动机的不同影响；3）发现增加临床监测结果具有价值。为了建立有效的激励计划以支持减少物质使用和提高抗菌药物依从性，我们建议仔细选择激励幅度，并利用改善健康的内在动机和目标行为的外在奖励。除了这些参与者所描述的优势外，纳入与激励计划相关的临床监测结果，为参与者提供更多关于其健康的信息，也可能有助于增强与健康相关的能力。