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BEST Study: Behavioral Economics for HIV Treatment Adherence Uganda

Uganda, East Africa

The BEST (Behavioral Economic Incentives to Support HIV Treatment Adherence) study in Uganda tests lottery-based incentives to overcome "present bias"—the tendency to prioritize immediate costs over long-term health benefits. Unlike costly traditional incentives ($1000+), behavioral economics-informed small, frequent prizes leverage probability overweighting. The study compares incentives tied to clinic visits/viral suppression versus electronically measured daily adherence, addressing why only ~60% of people with HIV take medications as prescribed.

Behavior Goal

Improve antiretroviral therapy (ART) adherence through behaviorally-informed lottery incentives that overcome present bias

Implementers & Partners

  • Mbarara University of Science and Technology
  • University of California San Francisco
  • Harvard Medical School

Donors & Sponsors

  • NIH/NIAID
  • Doris Duke Charitable Foundation

Key Takeaways

  • 1Present bias causes patients to prioritize avoiding immediate medication side effects over long-term health
  • 2Small, frequent lottery rewards can be more effective than large traditional incentives
  • 3Humans overweight small probabilities—lotteries leverage this cognitive bias
  • 4Commitment devices help shift decisions from "hot" emotional to "cold" rational states

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