Conditional Incentives Research Articles

Payments for ecosystem services did not crowd out pro-environmental behavior: Long-term experimental evidence from Uganda

Payments for ecosystem services (PES) are increasingly being implemented worldwide as conservation instruments that provide conditional economic incentives to landowners for a prespecified duration. However, in the psychological and economic literature, critics have raised concerns that PES can undermine the recipient's intrinsic motivation to engage in pro-environmental behavior. Such "crowding out" may reduce the effectiveness of PES and may even worsen conservation outcomes once programs are terminated. In this study, we harnessed a randomized controlled trial that provided PES to land users in Western Uganda and evaluated whether these incentives had a persistent effect on pro-environmental behavior and its underlying behavioral drivers 6 y after the last payments were made. We elicited pro-environmental behavior with an incentivized, experimental measure that consisted of a choice for respondents between more and less environmentally friendly tree seedlings. In addition to this main outcome, survey-based measures for underlying behavioral drivers captured self-efficacy beliefs, intrinsic motivation, and perceived forest benefits. Overall, we found no indications that PES led to the crowding out of pro-environmental behavior. That is, respondents from the treatment villages were as likely as respondents from the control villages to choose environmentally friendly tree seedlings. We also found no systematic differences between these two groups in their underlying behavioral drivers, and nor did we find evidence for crowding effects when focusing on self-reported tree planting behavior as an alternative outcome measure.

Global patterns of collective payments for ecosystem services and their degrees of commodification

This study provides a novel framework for analysing PES-related degrees of ES-commodification. The framework differentiates PES programs by the extent to which ES are traded in a market-like exchange in terms of four PES design components. We apply this framework to a newly compiled global dataset of collective PES programs (C-PES). C-PES address communities and groups instead of individuals and private entities and provide voluntary, conditional incentives for ES protection. Many conservationists see potentials for supporting participation and cooperation when linking common land titles with the PES approach instead of strengthening private land tenure regimes. We identified 29 C-PES cases with clusters in Central and Southeast Africa, Central America, and Southeast Asia. Particularly C-PES programs focusing on carbon or wildlife ES reach medium to high degrees of commodification, whereas schemes targeting biodiversity, watershed, or bundled ES show rather low to medium degrees of commodification. Our framework allows for a more nuanced study of the pluralism of PES designs and lays the foundation for further research on the differentiated role of ES-commodification for social-ecological outcomes.

Conditioned anti-immobility by ketamine: A comparison to escitalopram and bupropion.

This study was designed to explore the clinical belief that "set and setting" play an important role in favorable responses to psychedelic agents such as ketamine (KET). In fact, there is evidence in animals that the antidepressant effect of this drug may involve drug-environment interactions in which a context paired with its effects acquires the ability to influence behavior. Therefore, it was investigated in male Sprague-Dawley rats whether exposure to a context paired with the effects of KET, or with the effects of the common antidepressant medications bupropion (BUP) and escitalopram (ESC), could produce an antidepressant-like conditioned response. In Experiment 1, subjects received saline in a vehicle-paired context (denoted as CS-), and 0, 10, or 20 mg/kg KET, 10 mg/kg ESC, or 10 mg/kg BUP in a drug-paired context (denoted as CS +), on 10 alternating days (5 pairings with each context). The rats were then exposed drug free to the CS- and CS + prior to the assessment of immobility in the forced-swimming test. Experiment 2 assessed approach/avoidance responses induced by the CS- and CS + in a place-conditioning test. It was found that exposure to the KET CS + significantly reduced immobility without affecting general locomotor activity in comparison to the SAL CS + and the BUP CS +, but not the ESC CS+. Moreover, no group differences were observed in the place-conditioning test, indicating that the anti-immobility effect of the KET CS + was likely not influenced by a conditioned incentive or aversive state. Together, these data suggest that a KET-paired context can elicit a conditioned antidepressant-like response, which may be a mechanism involved in its sustained antidepressant clinical action. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Community Mobilization and Community Incentivization (CoMIC) Strategy for Child Health in a Rural Setting of Pakistan: Study Protocol for a Randomized Controlled Trial.

Despite the decline in under-five mortality by over 60% in the last three decades, majority of child mortality is still attributable to communicable and infectious diseases that are not only preventable, but they are also treatable. We evaluated the potential impact of a participatory community engagement and innovative community incentivization (C3I) strategy for improving the coverage of child health interventions in a rural setting in Pakistan. We first undertook formative research to assess community knowledge and the likelihood of collective community strategy and conditional incentives for improving existing preventive and care-seeking practices for childhood diarrhea and pneumonia. We developed options for community incentivization and improving group practices, taking local norms and customs into account in the design of the community mobilization strategies and messages. These interventions were then formally evaluated prospectively in a three-arm cluster randomized controlled trial. Clusters were randomly assigned by a computer algorithm using restricted randomization by an external statistician (1:1:1) into three groups: community mobilization and incentivization (CMI); community mobilization only using an enhanced communication package (CM); and control group. The C3I was an innovative strategy as it involved serial incremental targets of collective improvement in community behavior related to improvement in the coverage of a composite indicator of fully immunized children (FIC), oral rehydration salt (ORS), and the sanitation index (SI). The evaluation was done by an independent data collection and analysis team at baseline and end line (after 24 months).

Impact of different financial incentive structures on a web-based health survey: do timing and amount matter?

Financial incentives improve response to electronic health surveys, yet little is known about how unconditional incentives (guaranteed regardless of survey completion), conditional incentives, and various combinations of incentives influence response rates. We compared electronic health survey completion with two different financial incentive structures. We invited women aged 30-64 years enrolled in a U.S. healthcare system and overdue for Pap screening to complete a web-based survey after receiving a mailed human papillomavirus (HPV) self-sampling kit in a pragmatic trial. HPV kit returners (n = 272) and non-returners (n = 1,083) were allocated to one of two different incentive structures: (1) Unconditional: $5 pre-incentive only (n = 653); (2) Combined: $2 pre-incentive plus $10 post-incentive conditional on completion (n = 702). Chi-square tests evaluated whether survey completion differed by incentive structure within kit return groups or was modified by kit return status. For each incentive-by-kit status group, the cost-per-survey response was calculated as: ([number invited*pre-incentive amount] + [number responses*post-incentive amount]) / number responses. Overall, survey response was higher in kit returners vs. kit non-returners (42.6% vs. 11.0%, P < 0.01), and survey response was higher in the combined (20.1%) vs. unconditional (14.4%) incentive group (P = 0.01). Kit return status did not modify the association between incentive type and survey response (P = 0.52). Among respondents, time to survey completion did not differ by incentive type among either kit returners or non-returners. Among returners, the cost-per-survey response was similar between groups ($13.57 unconditional; $14.15 combined); among non-returners, the cost was greater in the unconditional ($57.78) versus the combined ($25.22) group. A combined incentive can be cost-effective for increasing survey response in health services research, particularly in hard-to-reach populations.

Secure Battery Swapping: A Reservation Scheme with Conditional Privacy-Preserving Bidirectional Heterogeneous Aggregate Signcryption and Incentive Mechanism

For large-scale battery-swapping demands, reserva- tions are utilized to effectively manage battery swapping. To achieve data security, one promising solution is heterogeneous signcryption (i.e. signature + encryption). However, existing heterogeneous signcryption cannot simultaneously support aggre- gation, batch verification, conditional privacy-preserving, bidirec- tional heterogeneous communication, and availability. Besides, to reduce the end-to-end delays, mobile edge computing (MEC) is introduced to reservations, so other challenge is to design an incentive mechanism to encourage mobile edge nodes (MENs) to transmit reservation messages. Seeking to address these chal- lenges, we propose a reservation scheme with conditional privacy- preserving bidirectional heterogeneous aggregate signcryption and incentive mechanism, namely SecBS. More precisely, in status publication (i.e. SecBS-SP), electric vehicles (EVs) obtain status messages released by battery swapping stations (BSSs) via MENs, which is realized via heterogeneous signcryption from certificateless cryptosystem (CLC) to identity-based cryptosystem (IBC). In the reservation (i.e. SecBS-R), under the incentive, MENs transmit reservations sent by EVs to BSSs, which is realized via heterogeneous signcryption from IBC to CLC. Finally, formally security proof and extensive simulations are carried out to manifest the security and feasibility of our SecBS.

Quasi-experimental evaluation of a financial incentive for first-dose COVID-19 vaccination among adults aged ≥60 years in South Africa

IntroductionCOVID-19 vaccination coverage in South Africa (RSA) remains low despite increased access to vaccines. On 1 November 2021, RSA introduced the Vooma Voucher programme which provided a small guaranteed financial...

Interventions to increase the uptake and continuation of pre-exposure prophylaxis (PrEP) by adolescent girls and young women at high risk of HIV in low-income and middle-income countries: a scoping review

IntroductionEffective strategies to increase pre-exposure prophylaxis (PrEP) uptake and continuation among adolescent girls and young women (AGYW) who engage in sex work or transactional sex are sparsely reported. We aimed...

Designing locally-appropriate conservation incentives for small-scale fishers

Large, long-lived marine animals (‘marine megafauna’) are amongst the world's most threatened taxa, primarily due to overfishing. Reducing fisheries' impacts on marine megafauna is particularly challenging in small-scale fisheries (SSFs), where endangered species can have important consumptive use values. Payments for ecosystem services (PES) have been proposed as a potential solution, but there is a lack of empirical data on if and how they might work in this context. We present a novel combination of methods – scenario interviews with contingent valuation (CV) – for exploring and designing locally-appropriate PES schemes; and apply these methods to investigate how different types of incentives might influence fisher behaviour and mortality of Critically Endangered taxa in two case study SSFs in Indonesia. Fishers almost unanimously supported positive conditional incentives: 98 % and 96 % of fishers would stop landing hammerhead sharks (Sphyrna spp.) and wedgefish (Rhynchobatus spp.), respectively, in contrast to 1 % and 6 % under a business-as-usual scenario, and 52 % and 46 % in response to a negative incentive (fine). CV results showed that an incentive-based scheme for catch mitigation of all hammerheads and wedgefish across both sites could cost US$71,408–235,927 annually, and save up to 18,500 and 2140 individuals, respectively. This study provides empirical evidence that PES could offer a cost-effective and socially-just approach for marine conservation in SSFs; and offers a scalable method for designing locally-appropriate investment-ready schemes, which could support the delivery of societal goals such as net positive outcomes for marine biodiversity and a sustainable and equitable blue economy.

Incentives and Reminders to Improve Long-term Medication Adherence (INMIND): Protocol for a Pilot Randomized Controlled Trial.

Nonadherence to antiretroviral therapy (ART) among people living with HIV is a crucial barrier to attaining viral suppression globally. Existing behavioral interventions have successfully increased ART adherence, but typically show only short-term impact that dissipates after the interventions are withdrawn. This study aims to test the feasibility, acceptability, and preliminary efficacy of a novel intervention that uses SMS text messages and conditional incentives to support ART initiators in establishing pill-taking habits. A sample of 150 participants aged ≥18 years who have initiated ART in the preceding 3 months will be recruited from Mildmay Uganda in Kampala, Uganda. All (150/150, 100%) participants will be educated on the anchoring strategy and will choose an existing routine to pair with their daily ART adherence from a set of 3 suggested routines: getting dressed in the morning, eating breakfast, or eating dinner. Then, participants will be randomized to receive either usual care (control group: 50/150, 33.3%) or 1 of the 2 interventions delivered over 3 months: daily SMS text message reminders to follow their chosen anchoring plan (messages group; treatment group 1: 50/150, 33.3%) or daily SMS text messages and incentives conditional on taking their ART medication around the time of their chosen anchor (incentives group; treatment group 2: 50/150, 33.3%). Long-term ART adherence will be evaluated for 6 months after the intervention, and survey assessments will be conducted at baseline, 3 months, and 9 months. Outcomes include feasibility and acceptability measures and intervention efficacy outcomes defined by electronically measured mean medication adherence during the intervention and during the 6 months after the intervention, along with a measure of routine ART adherence based on taking medications around the time of participants' anchor during the intervention and during the 6 months after intervention. As of February 18, 2022, recruitment was completed. A total of 150 participants were recruited, and data collection is expected to end in December of 2022. Final results are expected to be submitted for publication by April 2023. This study is the first to use behavioral economics-based interventions in combination with the anchoring strategy to improve long-term ART adherence among treatment initiators. We hypothesize that the combination of SMS text message reminders and incentives will increase participants' use of their anchoring strategy, and thus medication adherence will be better maintained after the intervention ends in our intervention groups relative to the control group that uses only the anchoring strategy. Results of this pilot study will help to refine this combined intervention approach for testing at scale and broaden our understanding of the habit formation process. ClinicalTrials.gov NCT05131165; https://clinicaltrials.gov/ct2/show/NCT05131165. DERR1-10.2196/42216.

Impact of conditional economic incentives and motivational interviewing on health outcomes of adolescents living with HIV in Anambra State, Nigeria: A cluster-randomised trial

BackgroundAdolescents living with HIV (ALHIV) have had worse outcomes compared to adults. They face enormous difficulty in accessing HIV care services. We hypothesize that conditional economic incentives (CEI) and motivational interviewing could increase retention in care, medication adherence and ultimately viral load suppression. Therefore, we evaluated the one-year impact of conditional economic incentives and motivational interviewing on the health outcomes of ALHIV in Anambra State, Nigeria. MethodsUsing a cluster-randomised design, we examined the one-year (from December 1, 2018, to November 30, 2019), individual-level impact of an Incentive Scheme comprising conditional economic incentives and motivational interviewing on achieving undetectable viral load (primary outcome), CD4+ count, adherence to antiretroviral therapy and retention in care (secondary outcomes) by ALHIV in Anambra State, Nigeria. Twelve HIV treatment hospitals were stratified according to the type of clinic (secondary or tertiary) and randomly assigned to the intervention arm or control arm to receive the Incentive Scheme or routine care, respectively. ALHIV aged 10–19 years, initiated into HIV care for a minimum of 6 months, and who adhered poorly to medications (<100% adherence rate) were eligible for the study. Participants in the intervention arm received motivational interviewing at the study baseline and every visit. They also received US$5.6 when HIV viral load (VL) was <20 copies/mL at month 3, US$2.8 if the VL remained suppressed at months 6 and 9, and US$5.6 if the VL remained <20 copies/mL at month 12. ResultsOf the 246 trial participants, 119 were in the intervention while 127 were in the control arm. There was no difference in the baseline characteristics of the participants between the intervention and control arm except for the number of participants with undetectable viral load and the number of participants with ≥95% adherence. Although participants in the intervention arm had a 10.1% increase while those in the control arm had a 1.6% decrease in proportion with undetectable viral load (≤20 copies/ml) after 12 months, the change in the primary outcome was not statistically significant. Similarly, the differences in the secondary outcomes were not statistically significant. ConclusionThe Incentive Scheme did not improve the virologic outcome of ALHIV after 12 months. Differences in the secondary outcomes after 12 months were also not significantly different from the baseline. Trial registrationWe registered the trial retrospectively with The Pan African Clinical Trials Registry: https://pactr.samrc.ac.za/(PACTR201806003040425) on 2/2/2018.

Can a conditional financial incentive (CFI) reduce socio-demographic inequalities in home-based HIV testing uptake? A secondary analysis of the HITS clinical trial intervention in rural South Africa

In sub-Saharan Africa, home-based HIV testing interventions are designed to reach sub-populations with low access to HIV testing such as men, younger or less educated people. Combining these interventions with conditional financial incentives (CFI) has been shown to be effective to increase testing uptake. CFI are effective for one-off health behaviour change but whether they operate differentially on different socio-demographic groups is less clear. Using data from the HITS trial in South Africa, we investigated whether a CFI was able to reduce existing home-based HIV testing uptake inequalities observed by socio-demographic groups. Residents aged ≥15 years in the study area were assigned to an intervention arm (16 clusters) or a control arm (29 clusters). In the intervention arm, individuals received a food voucher (∼3.5 US dollars) if they accepted to take a home-based HIV test. Testing uptake differences were considered for socio-demographic (sex, age, education, employment status, marital status, household asset index) and geographical (urban/rural living area, distance from clinic) characteristics. Among the 37,028 residents, 24,793 (9290 men, 15,503 women) were included in the analysis. CFI increased significantly testing uptake among men (39.2% vs 25.2%, p < 0.001) and women (45.9% vs 32.0%, p < 0.001) with similar absolute increase between men and women. Uptake was higher amongst the youngest or least educated individuals, and amongst single (vs in union) or unemployed men. Absolute uptake increase was also significantly higher amongst these groups resulting in increasing socio-demographic differentials for home-based HIV testing uptake. However, because these groups are known to have less access to other public HIV testing services, CFI could reduce inequalities for HIV testing access in our specific context. Although CFI significantly increased home-based HIV testing uptake, it did not do so differentially by socio-demographic group. Future interventions using CFI should make sure that the intervention alone does not increase existing health inequities.

A comparison of survey incentive methods to recruit rural cancer survivors into cancer care delivery research studies.

Unconditional (upfront) incentives are proposed to improve acceptance of cancer research among underrepresented, racial/ethnic minority populations, but few studies have tested incentive strategies among rural cancer survivors. Descriptive statistics summarized demographic characteristics of survey respondents, and response rates by arm were compared using Chi-square tests. We compared upfront ($2) and response-based ($10 conditional) incentives in a mailed survey of adult post-treatment rural survivors. Individuals meeting eligibility criteria from the electronic medical record (n = 2,830) were randomized into two incentive arms (n = 1,414 for the upfront arm and n = 1,416 for the contingent arm). Of the total delivered, presumed eligible participants (n = 1,304 upfront arm; n = 1,317 contingent arm), 67.8% were aged 65y+, 49.8% were female, and 95.1% were non-Hispanic white. The response rate for all participants was 18.5%. We received eligible surveys from 281 rural survivors in the first arm (response rate: 21.5%); and 205 surveys in the second arm (response rate: 15.6%). Participants who received the upfront incentive had a higher response rate than those receiving a response-based incentive, X2 (1, 2,621) = 15.53, p < 0.0001. Incentivizing survey completion with an upfront $2 bill encouraged a higher survey response rate; other supplemental strategies are needed to achieve a higher response rate for this population.

Examining the Implementation of Conditional Financial Incentives Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to Improve HIV Outcomes among Persons Living with HIV (PLWH) in Louisiana.

Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). The Baton Rouge Positive Pathway Study (BRPPS), a mixed method implementation science study, was conducted to assess key RE-AIM components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Seven hundred and eighty-one (781) PLWH enrolled at four HIV clinic sites were included in the final analyses. Participants completed an initial baseline survey, viral load test, and were contacted at 6 and 12 months (±1 month) post-enrollment for follow-up labs to monitor viral load levels. Participants received up to USD140 in conditional financial incentives. The primary analyses assessed whether participation in the BRPPS was associated with an increase in the proportion of participants who were: (a) engaged in care, (b) retained in care and (c) virally suppressed at baseline to 6 and 12 months post-baseline. We constructed a longitudinal regression model where participant-level outcomes at times t0 (baseline) and t1 (6- or 12-month follow-up) were modeled as a function of time. A secondary analysis was conducted using single-level regression to examine which baseline characteristics were associated with the outcomes of interest at 12-month follow-up. Cost analyses were also conducted with three of the participating clinics. Most participants identified as Black/African American (89%). Fewer than half of participants reported that they were unemployed or made less than USD5000 annually (43%). Over time, the proportion of participants engaged in care and retained in care significantly increased (70% to 93% and 32% to 64%, p < 0.00). However, the proportion of virally suppressed participants decreased over time (59% to 34%, p < 0.00). Implementation costs across the three sites ranged from USD17,198.05 to USD396,910.00 and were associated with between 0.37 and 1.34 HIV transmissions averted at each site. Study findings provide promising evidence to suggest that conditional financial incentives could help support engagement and retention in HIV care for a high need and at risk for falling out of HIV care population.

Extortion, intuition, and the dark side of reciprocity

Extortion occurs when one person uses some combination of threats and promises to extract an unfair share of benefits from another. Although extortion is a pervasive feature of human interaction, it has received relatively little attention in psychological research. But, we argue, extortion is structured quite similarly to far better-studied “reciprocal” social behaviors, such as conditional cooperation and retributive punishment. All of these strategies function to elicit some desirable behavior from a social partner and do so by constructing conditional incentives. The main difference is that the desired behavioral response is an unfair or unjust allocation of resources during extortion, whereas it is typically assumed to be a fair or just distribution of resources in studies of reciprocal cooperation and punishment. Thus, we propose that a common set of psychological mechanisms may render these strategies successful. We know from prior work that prosocial forms of reciprocity often work best when implemented inflexibly and intuitively, rather than deliberatively. This both affords long-term commitment to the reciprocal strategy, and also signals this commitment to social partners. We argue that, for the same reasons, extortion is likely to depend largely upon inflexible, intuitive psychological processes. Several existing lines of circumstantial evidence support this conjecture.

Conditional Economic Incentives for HIV Treatment Adherence: Aligning Adolescent Developmental Hallmarks with Behavioral Economic Theory to Improve HIV Treatment Adherence.

Adolescent-tailored antiretroviral therapy (ART) adherence interventions take place within the context of unique developmental stage. Suboptimal ART adherence among adolescents living with HIV in South Africa underscores that interventions are urgently needed to improve adherence. We conducted semistructured in-depth interviews with 35 adolescents aged 10-19 years living with HIV. In addition, 14 clinicians and 35 caregivers were interviewed to provide a diverse perspective on barriers and facilitators of medication adherence for adolescents living with HIV (ALWH). Thematic coding was utilized for this analysis. Our main findings were organized by following a priori themes: (1) acceptability of conditional economic incentives (CEIs) as an adherence intervention strategy for adolescents, (2) predicted behavioral impacts, and the (3) durability of CEIs to ensure medication adherence for adolescents in the long term. Subthemes that emerged included CEIs as tool to overcome competing demands, increasing intrinsic motivation and orientation toward the future, and optimal timing of the intervention. Exposure to a CEI intervention during early adolescence (ages 10-13) may be a particularly helpful intervention as CEIs may have long-lasting effects given that habit-formation behavior is developed during early adolescence. There is little consensus on effect duration from the perspective of adolescents, clinicians, and caregivers. Future studies should continue to explore the impact of CEIs for long-term ART adherence.

Contradictory distributive principles and land tenure govern benefit-sharing of payments for ecosystem services (PES) in Chiapas, Mexico

Payments for Ecosystem Services (PES) are incentive-based instruments that provide conditional economic incentives for natural resources management. Research has shown that when economic incentives are parachuted into rural communities, participation and benefits are collectively negotiated and shared. However, we know little about how benefit-sharing evolves over time in community-based PES. To address this gap, we examine distributional justice in four communities of the state of Chiapas, Mexico, which participate in a PES programme, and we assess how local justice principles compare with the programme’s goals. Our analysis reveals patterns of both continuity and change in how communities share PES benefits, which reflect a suite of contradictory justice principles, including entitlement, merit, need, and equality. The studied communities distribute PES benefits by providing differentiated compensation to diverse groups of landholders via private cash payments, whilst also attending non-landed community members through public infrastructure investments. We show that benefit-sharing is strongly influenced by pre-existing land tenure features and associated norms, which in the study area include three different types of individual and common-property. Yet, we also show that communities continuously adjust benefit-sharing arrangements to navigate distributional challenges emerging from programme engagement. Overall, we provide novel insights on the evolution, diversity, and complexity of distributive justice in community-based PES and we advocate for a context-sensitive, nuanced, and dynamic account of justice in incentive-based conservation.

Interventions to Improve Treatment Outcomes among Adolescents on Antiretroviral Therapy with Unsuppressed Viral Loads: A Systematic Review.

Adolescents living with HIV (ALHIV) face unique developmental challenges that increase the risk of unsuppressed viral loads. Current reviews present a need for proven interventions to improve viral suppression among ALHIV on ART, who have a history of unsuppressed viral loads. This systematic review aims to synthesize and appraise evidence of the effectiveness of interventions to improve treatment outcomes among ALHIV with unsuppressed viral loads. Six bibliographic databases were searched for published studies and gray literature from 2010 to 2021. The risk of bias and certainty of evidence was assessed using the ROBINS-I tool, CASP checklists and GRADE. A total of 28 studies were eligible for full-text screening; and only three were included in the qualitative synthesis. In addition, two studies were included from website searches. Four types of interventions to improve viral suppression were identified, namely: intensive adherence counselling; community- and facility-based peer-led differentiated service delivery (DSD); family based economic empowerment; and conditional economic incentives and motivational interviewing. We strongly recommend peer-led community-based DSD interventions, intensive adherence counselling, and family-based economic empowerment as potential interventions to improve viral suppression among ALHIV.

How Does International Intervention Work to Secure Peace Settlements After Civil Conflicts?

AbstractThere is an emerging consensus that international intervention can secure peace by helping combatants resolve commitment problems following civil wars. But how do interveners accomplish this? Some suggest that intervention primarily works through military coercion, while others propose non-military instruments. We build on the existing literature to theorize that interveners commonly condition political, economic, and legal incentives on compliance with peace processes. Despite a rich literature on intervention, scholars have only started to test the underlying instruments. This article takes a critical step toward this end, examining peacekeeping missions led by the United Nations from 1989 to 2012. Contrary to conventional wisdom, we show military coercion is neither commonly used nor necessary to ensure peace. Missions that employ conditional incentives—on which we collect original data—are consistently correlated with a reduced risk of conflict recurrence, even when controlling for observed selection effects, and regardless of whether they are also authorized to use military coercion.

Attitudes towards and experiences with economic incentives for engagement in HIV care and treatment: Qualitative insights from a randomized trial in Kenya.

Growing literature has shown heterogenous effects of conditional cash incentives (CCIs) on HIV care retention. The field lacks insights into reasons why incentives impact various patients in different ways-differences that may be due to variations in psychological and social mechanisms of effect. A deeper understanding of patients' perceptions and experiences of CCIs for retention may help to clarify these mechanisms. We conducted a qualitative study embedded in the ADAPT-R trial (NCT#02338739), a sequential multiple assignment randomized trial (SMART) that evaluated economic incentives to support retention in HIV care among persons living with HIV (PLHIV) initiating antiretroviral therapy in Kenya. Participants who attended their scheduled clinic visits received an incentive of approximately $4 each visit. Interviews were conducted between July 2016 and June 2017 with 39 participants to explore attitudes and experiences with economic incentives conditional on care engagement. Analyses revealed that incentives helped PLHIV prioritize care-seeking by alleviating transport barriers and food insecurity: "I decided to forgo [work] and attend clinic […] the voucher relieved me". Patients who borrowed money for care-seeking reported feeling relieved from the burden of indebtedness to others: "I borrow with confidence that I will pay after my appointment." Incentives fostered their autonomy, and enabled them to support others: "I used the money to buy some clothes and Pampers for the children." Participants who were intrinsically motivated to engage in care ("my life depends on the drugs, not the incentive"), and those who mistrusted researchers, reported being less prompted by the incentive itself. For patients not already prioritizing care-seeking, incentives facilitated care engagement through alleviating transport costs, indebtedness and food insecurity, and also supported social role fulfillment. Conditional cash incentives may be an important cue to action to improve progression through the HIV treatment cascade, and contribute to better care retention.