A Commitment Device for Medication Adherence Among HIV Patients

• CD4 Counts [ Time Frame: Up to three years ] [ Designated as safety issue: No ]
  The investigators will measure the patients' CD4 counts to see if they have changed due to a change in health behavior.
• Provider Check-up Attendance [ Time Frame: Up to 3 years ] [ Designated as safety issue: No ]
  The investigators will track attendance at provider check-ups to measure patients' adherence to the health plan set out by their physician.
• Adherence to Medical Regimen [ Time Frame: Up to three years ] [ Designated as safety issue: No ]
  The investigators will measure patients' adherence to their medical regimen.
• Attitude and Motivation [ Time Frame: Up to two years ] [ Designated as safety issue: No ]
  The investigators will measure patients' attitude and motivation through the use of surveys.
• Demographic Considerations [ Time Frame: Up to two years ] [ Designated as safety issue: No ]
  The investigators will examine demographic characteristics to see if there are correlates to other outcomes.

The goal is to improve HIV patients' adherence to medication regimens. The investigators are planning an intervention in which the patient is given financial incentives to take clinic attendance seriously, and then given the option to make these incentives contingent on taking medications as prescribed—that is, to require better behavior from themselves to earn the same reward. Past studies have shown that conditional payments improve adherence to HIV treatment, but only while payments are being made. The investigators expect that patients will be willing to give up some payments to commit themselves to better adherence. The investigators also hope to see some patients maintaining good adherence after financial incentives are removed, among those who are given the opportunity to choose this commitment.

• Acquired Immunodeficiency Syndrome
• HIV

• Experimental: Incentive Choice Arm
  In the Incentive Choice arm, patients will first be presented with a brief explanation of the differences between the Attend-Check-up-Get-Paid arm and the Take-Meds-Get-Paid arm. The RC has a paper diagram that he will use in the explanation. Only after patients make a decision are they given a full walk-through of what they need to do to receive their incentive payment, as in the above Attendance Incentive arm. There is the question of how much detail we might want to shift from the walk-through to the initial brief explanation of the Attend-Check-up-Get-Paid arm and the Take-Meds-Get-Paid arm.
  Intervention: Other: Medication Adherence among HIV/AIDS Patients
• Experimental: Attendance Incentive Arm
  In the Attendance Incentive arm, patients will be given a walk-through of what they need to do to receive their incentive payment, which would include attending their provider check-up, seeing the RC and remembering to bring their MEMs bottle.
  Intervention: Other: Medication Adherence among HIV/AIDS Patients

Inclusion Criteria:

• The patient's most recent ART regimen has been in place for at least 24 weeks, counting back from the patient's most recently scheduled provider check-up.
• Of viral load assays taken at least 24 weeks after the start of the patient's most recent ART regimen, the latest assay is higher than 400 copies/mL.
• Patient is at least 18 years of age.
• Patient collects his/her HIV medication only from the Ponce clinic.
• Patient is not involved in another study.
• Patient is not currently using a pill box or organizer.
• Patient is not moving out of the area within the next 18 months.
• Patient is not on the do-not-contact list.

Exclusion Criteria:

• Patient is involved in another study.
• Patient uses a pill box or organizer.
• Patient is moving out of the area in the next 18 months.
• Patient is on the do-not-contact list.