INcentives and ReMINDers to Improve Long-term Medication Adherence (INMIND)

Low medication adherence when initiating antiretroviral treatment (ART) is a key barrier to HIV virologic suppression, resulting in avoidable cases of drug resistance, death, and viral transmission. Routinized pill-taking can lead to successful long-term ART adherence, and short-term behavioral economics-based supports are a novel way to overcome the limited success of existing routinization interventions. This study proposes to test this combined approach for promoting long-term ART adherence using a Stage III Sequential, Multiple Assignment, Randomized Trial (SMART) design in one of the largest HIV clinics in Uganda to identify the most cost-effective adaptive intervention that if found effective is generalizable to other settings and other chronic diseases.

Inclusion Criteria: * Male and female clients age 18 and older. * Started ART at Mildmay or another clinic within the preceding 2 months * Able to speak and understand either English or Luganda. * Have their own cell phone or have consistent access to someone else's phone. * Willing to receive daily text messages for the 6 months of intervention duration. * Willing and able to use the WisePill device distributed for adherence verification for the duration of the study. Exclusion Criteria: * Not mentally fit to consent. * Language other than Luganda or English. * Not willing to consistently use the Wisepill device for adherence measurement.