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

Building on a previous R34 study, the investigators will adapt and deliver the INMIND approach to 550 ART initiators at Mildmay. Participants will initially be randomized to receive either usual care (Control, n=275) or daily text messages (Messages, n=275) to support adherence routines. At months 1 and 2, participants may revise their adherence plans. Those showing <80% adherence in month 3 will be re-randomized to receive either monthly or monthly escalated prize incentives for the next three months. Adherence will be monitored for an additional 12 months (total follow-up: 18 months) to assess long-term routine maintenance and recovery after interruptions. The SMART design will help identify the most cost-effective intervention sequencing. A cost-effectiveness analysis and stakeholder dissemination will support future scale-up. The investigators hypothesize that Messages will be more effective than Control as a first-stage treatment; that monthly escalated prizes will be more effective than monthly prizes as a second-stage treatment; and that the mechanisms of lack of Salience and Present Bias will mediate the effect of INMIND on our primary and secondary outcomes.

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.