Date of Award

2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Social Welfare

First Advisor

Andrea Doyle

Abstract

With the introduction of Highly Active Anti-Retro Viral Therapy (HAART), Human Immunodeficiency Virus (HIV) infection has become a manageable chronic condition (Deeks, Lewin & Havlir, 2013). Research suggests that if all HIV positive individuals could be identified and immediately started on HAART and if, they maintained good adherence to the medication, the HIV/AIDS epidemic could be effectively controlled and eventually eliminated (Granich, Gilks, Dye, De Cock & Williams, 2009). However, adherence to HAART remains a challenge for those living with HIV and their health care providers (Nachega et al., 2012; Mills et al., 2006). Efforts are underway to improve adherence to HAART among people living with HIV/AIDS (Chaiyachati, Ogbuoji, Price, Suthar, Negussie & Barnighausen, 2014). Financial incentives have been shown to be effective in improving adherence to HAART (Giles, Robalino, McColl, Sniehotta & Adams, 2014). However, the way financial incentives work to promote adherence behaviors in a clinical setting needs to be better understood before large-scale interventions are developed using this tool. The present study employed a Constructivist Grounded Theory approach (Charmaz, 2006) to qualitatively answer the question: How does the provision of financial incentives affect the process of adherence to anti-retroviral medication in individuals with HIV infection? The study was conducted at Housing Works, which is a community based HIV service organization in New York City. The participants were recruited from an adherence promotion intervention implemented by Housing Works, The Viral Load Suppression (VLS) program, which used financial incentives along with other services to promote adherence. Results indicate that there were symbolic and material aspects to the effects of financial incentives on motivation to adhere to medication. The context specific facilitators of and barriers to adherence were both influenced by financial incentives and the facilitating factors, in turn, influenced the effect of the incentives. The implications of the results are discussed specifically with regards to theory development, practice directives, policy recommendations and future directions for research in financial incentives to promote adherence to HAART.

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