Financial incentives increase viral suppression in HIV patients
Gift cards used as financial incentives significantly increased viral suppression and continuity in care among patients with HIV, according to a recent study published in JAMA Internal Medicine.
The study, HPTN 065, is the largest to date that examines the effect of financial incentives on HIV–related care outcomes, according to Wafaa El-Sadr, MD, MPH, of the Mailman School of Public Health at Columbia University, and colleagues.
For the study, the researchers randomly designated 37 HIV test centers and 39 HIV care centers in the Bronx, New York, and Washington D.C. — two areas in the U.S. severely affected by HIV — as sites offering financial incentives or standard of care. The financial incentives included coupons redeemable for two cash-equivalent gift cards — one totaling $25 for getting blood drawn for HIV–related tests, and another totaling $100 for meeting with a clinician to develop a care plan — for patients who tested positive at a financial incentive site. Meanwhile, those with viral suppression (HIV RNA < 400 copies/mL) on ART were eligible for a $70 gift card once every 3 months. The incentives were offered from April 2011 to December 2012 at the HIV test sites and from February 2011 to January 2013 at the HIV care sites.
Over the study period, 1,061 coupons were distributed for linkage to care at 18 financial incentive sites, and 39,359 gift cards were awarded to 9,641 eligible patients at 17 financial incentive sites.
Although the overall percentage of patients with viral suppression increased during the study period at both financial incentive and standard-of-care sites, the proportion of patients with viral suppression was 3.8% (95% CI, 0.7%-6.8%) higher at the financial incentive care sites.
“While seemingly modest, an increase of 4% in viral suppression with financial incentives may potentially have considerable clinical and preventive implications on a population level, particularly in settings and among patients with less robust viral suppression,” the researchers wrote.
Among a subset of patients whose viral load was not consistently suppressed at baseline, viral suppression was 4.9% (95% CI, 1.4%-8.5%) higher at financial incentive sites vs. standard-of-care sites. In addition, the proportion of patients reporting regular attendance to clinic visits was 8.7% (95% CI, 4.2%-13.2%) higher at financial incentive sites compared with standard-of-care sites. However, financial incentives did not appear to have an impact on linkage to care.
El-Sadr and colleagues noted that the use of financial incentives to motivate behavior is controversial; however, they took measures to avoid “untoward consequences.” They added that additional analyses are needed to determine the cost-effectiveness of offering financial incentives to patients.
“In conclusion, while our findings offer an innovative intervention for achieving the treatment and prevention potential of [ART], a strategy that offers great promise for control of HIV in the United States and globally, more research is needed to determine how such an intervention can be implemented in programs and at scale,” they wrote. – by Stephanie Viguers
Disclosure: El Sadr reports receiving grants from the National Institute of Allergy and Infectious Diseases. Please see the full study for a list of all other authors’ relevant financial disclosures.