YBank
Combining financial incentives and peer support to improve HIV treatment adherence among adolescents
Challenge
HIV is evolving into an adolescent epidemic. Globally, 2.1 million adolescents and 3.3 million children are living with HIV/AIDS. Between 2005 and 2012 the total number of HIV-related deaths fell by 30%. However, amongst adolescents, HIV related deaths increased by 50%.
Despite the availability and long-term benefits of antiretroviral therapy (ART), adherence remains low among adolescents due to challenges related to cost, acquisition, and rigorous treatment regimen. Poor ART adherence is driving poor outcomes for adolescents.
Innovation
YLabs worked with Rwandan youth living with HIV, their communities, and health workers to co-design YBank, a treatment adherence program that combined peer-led life skills training and financial incentives for attending regular clinic appointments. We then partnered with the Rwandan Ministry of Health and Partners in Health to pilot YBank in two districts of Rwanda to assess the program’s feasibility, acceptability, and potential for impact. YBank combines three components to improve adherence to ART:
Incentives: Using the power of both long- and short-term financial savings to motivate healthy choices and relieve the burden of treatment-related costs
Peer Support: Building a network of youths living with HIV helping each other to stick to medication regimens and stay healthy through peer mentoring sessions
Life Skills: Providing young people with the skills to invest their savings and plan their future livelihoods
“The program helped me to overcome despair. I feel brave and positive. This helped me to avoid stress and hopelessness and think every day about my future.”
Next Steps
Both youth and caregivers reported increased mental health and psychosocial support, relief in financial burden, and renewed commitment to treatment adherence. The program was found to be both feasible and acceptable, and is now intended to be tested in other communities at a larger scale. Financial incentives, combined with a supportive environment and adequate skills-training, show promise in motivating healthy behavior change in adolescents living with HIV.
“My child’s health is improving, and she is now more active in the support group. The peer mentors share their experience with the young adolescents, and then later, they get restored and positive about their future. Caregivers do not set time to talk to their children about the problem they have, or some other caregivers are shy to tell their children why they take medicines every day, so the peer mentors do it well and counsel the young adolescents.”
