The effectiveness of monetary incentives in improving viral suppression, treatment adherence, and retention in care among the general population of people living with HIV: a systematic review and meta-analysis.

Background: Achieving and maintaining viral suppression and optimal adherence to antiretroviral therapy are crucial for improving health outcomes in general population of people living with HIV. This study aimed to evaluate the effects of monetary incentives on these key treatment goals.

Methods: We conducted a systematic review and meta-analysis, searching the Cochrane Library, Medline, EMBASE, CINAHL, Web of Science, and Scopus databases from inception to March 2025. We included randomized controlled trials comparing monetary incentives with routine care in people living with HIV. The primary outcomes were viral suppression and adherence to antiretroviral therapy. Random-effects meta-analyses were used to calculate pooled odds ratios with 95% confidence intervals. This study was registered with PROSPERO (registration number CRD42024524374).

Results: Thirteen randomized controlled trials were included. Compared with routine care, monetary incentives significantly improved viral suppression (OR = 1.39,95%CI: 1.11, 1.74); p = 0.004; I²=42%), adherence to antiretroviral therapy (OR = 1.62,95%CI: 1.13,2.31; p = 0.008; I²=30%) and retention in care (OR = 1.27, 95% CI: 1.02-1.57; p = 0.03; I²=9%). The difference in CD4 + T-cell counts between groups did not reach statistical significance (SMD = -38.90, 95% CI: -77.35 to -0.45; p = 0.05), with low heterogeneity (I² = 28%).

Conclusion: Monetary incentives effectively improve viral suppression and adherence to antiretroviral therapy among people living with HIV. Integrating monetary incentives into HIV care models could be a promising strategy to optimize treatment outcomes. Further research is needed to assess the long-term sustainability and cost-effectiveness of such interventions.