Financial Incentives Do Not Increase Linkage to Care or Viral Suppression
March 13, 2015
A large study presented at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle found that offering gift cards to people to reward them for getting into HIV care after testing positive or for getting their viral loads suppressed doesn't work better than the standard of care. The one exception where financial incentives did seem to work was in smaller clinics, hospital clinics and in people with low virus levels at care entry.
HIV Prevention Trials Network (HPTN) study 065 was designed to determine whether offering financial incentives to HIV-positive individuals would lead to better care outcomes, specifically linkage to HIV care and viral suppression. The instigator for the study was data showing that a significant proportion of those diagnosed with HIV are never linked to care and that an even smaller proportion achieve viral suppression. This has implications both for the health of the person living with HIV, as well as the likelihood that they may pass on HIV to others.
The study randomized 1,346 HIV-positive individuals to receive either financial incentives (FI) or standard of care at 34 HIV testing sites and 37 HIV care sites in the Bronx, New York and Washington, DC. The majority were men who have sex with men and most were black or Latino. At testing sites offering FI, people testing positive were given coupons redeemable for $125 if they had an HIV care visit within three months of testing positive. At care sites offering FI, people could earn $70 gift cards every three months if their virus was suppressed below 400 copies.
The study found that offering FI to people testing positive did not increase the likelihood that they would have a care visit within three months. Overall, the use of FI did not increase the likelihood that someone would achieve and maintain viral suppression. There was, however, a benefit to FI for viral suppression in smaller clinics, in hospital-based clinics and in people who had lower viral loads when they entered care.
Finally, FI also increased the odds that a person would remain continuously in care over time in certain situations. These included smaller clinics and in people with higher viral loads at study entry. As well, FI increased care continuity in both hospital- and community-based clinics.
El-Sadr, et al. "Effect of Financial Incentives on Linkage to Care and Viral Suppression: HPTN 065". 2015 CROI, Seattle, WA
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