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Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico

Author

Listed:
  • Omar Galárraga

    (Brown University School of Public Health
    Brown University School of Public Health)

  • Marta Wilson-Barthes

    (Brown University School of Public Health)

  • Carlos Chivardi

    (National Institute of Public Health (INSP)
    University of York)

  • Nathalie Gras-Allain

    (Clínica Especializada Condesa)

  • Fernando Alarid-Escudero

    (Center for Economics Teaching and Research (CIDE)
    Stanford University School of Medicine)

  • Monica Gandhi

    (University of California)

  • Kenneth H. Mayer

    (The Fenway Institute
    Harvard T.H. Chan School of Public Health)

  • Don Operario

    (Emory University)

Abstract

Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (

Suggested Citation

  • Omar Galárraga & Marta Wilson-Barthes & Carlos Chivardi & Nathalie Gras-Allain & Fernando Alarid-Escudero & Monica Gandhi & Kenneth H. Mayer & Don Operario, 2025. "Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(2), pages 299-311, March.
    • Handle: RePEc:spr:eujhec:v:26:y:2025:i:2:d:10.1007_s10198-024-01705-y
    DOI: 10.1007/s10198-024-01705-y
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    References listed on IDEAS

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    1. Packel, Laura J. & de Walque, Damien & Feeney, Kevin C. & Balampama, Marianna P. & Cooper, Jan E. & Kalolella, Admirabilis & Wechsberg, Wendee M. & Dow, William H., 2021. "A randomized trial of cash incentives for sexual behavior change among female sex workers in Dar es Salaam," Social Science & Medicine, Elsevier, vol. 272(C).
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