Supporting Adolescents to Adhere - an Intervention Using Airtime Rewards Allocated by a Prize Drawing
Condition: Human Immunodeficiency Virus
MeSH terms: Acquired Immunodeficiency Syndrome; HIV Infections
Study type: Interventional

Summary: 
      This study is an extension of Reminding Adolescents to Adhere (RATA) (Unique protocol ID:
      1R01HD074925-01). Participants for SATA will be recruited during the RATA month 24 exit
      survey.

      Participants will be randomized 1:1:1 into either one of two intervention group (receiving
      the weekly messages and a chance to draw a prize at each clinic visit based on either a fixed
      adherence level of 90% or a self-chosen one of at least 80% as further detailed below) or the
      control group that receives the existing RATA intervention consisting of weekly motivational
      messages and the chance to get mobile airtime rewards conditional on responding. Doing so
      will allow the investigators to cleanly evaluate the impact of these additional
      adherence-based lotteries, and guarantees that those who have been in the control group
      receiving standard of care in the first 24 months of the RATA intervention will also receive
      an intervention for reasons of fairness.
    

Detailed description: 
      -  For Group 1 (lottery reward with fixed target): Study coordinators check participant's
           MEMS extraction for last month's adherence. Study coordinators then tell participants of
           the participants' adherence in the last month. Participants are also informed that
           during the next clinic visit, if they adhere at least 90 percent they have a chance to
           enter into a game where they have a chance of winning mobile airtime, by drawing into a
           bag and picking a card associated with their airtime winnings. If they do not have 90%
           adherence, they will not receive the airtime award game, but there will be another
           chance the next time they come for their scheduled clinic visit during the study period.

        -  For Group 2 (lottery award with own target): Study coordinators check participant's MEMS
           extraction for last month's adherence. They inform participants of their adherence in
           the last month. In order to be eligible for an airtime reward game, during their next
           clinic visit they must reach their own target goal. The target adherence goal must be
           greater than 80%. Participants may, for example, choose 80%, 85%, 90%, 95%, or 100%.
           Again, if they meet or exceed this target they have a chance to draw into a bag to win
           mobile airtime. If they do not have meet this self-imposed target adherence, they will
           not be eligible to play the airtime award game, but there will be another chance the
           next time they come for their scheduled clinic visit during the study period.

      During each clinic visit, participants will have their MEMS extracted and study coordinators
      will check for average adherence between that day and the last clinic visit. For those who
      have met the target, coordinators will initiate the lottery, complete the drawing procedure,
      or send them the airtime reward without drawing (depending on which group).

      Every Sunday, study investigators will send treatment participants a motivational message to
      remind them about the reward. Within each of the two intervention groups, study investigators
      will randomly send the message either in a loss-frame or a gain-frame, i.e. an intervention
      participant (in either group) will some weeks receive a message telling them to keep up
      motivation (as a code-word for adherence) to win a prize, and some weeks telling them to make
      sure not to lose their chance to win a prize.
    

Intervention name(s): Own Adherence Group; Fixed Adherence Group; Control Group
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Participant chooses their adherence level to be reached at next clinic visit (at least 80%, but can be higher). If they reach that percentage measured using the MEMS cap, they can participate in a lottery for an airtime reward of none, a small amount, and a larger amount. Participants also receive a weekly motivational message reminding them of their incentive to adhere. If they respond to the message they will receive airtime top-up.; Participant is told to meet a pre-determined target of 90%. If they reach that percentage measured using the MEMS cap, they can participate in a lottery for an airtime reward of none, a small amount, and a larger amount. Participants also receive a weekly motivational message reminding them of their incentive to adhere. If they respond to the message they will receive airtime top-up.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: HIV; Antiretroviral (ARV); co-trimoxazole; SMS; Lottery incentive; mobile health; Uganda; Youth