Financial incentives increase viral suppression and clinic attendance among HIV-positive patients

The use of gift cards significantly increased viral suppression and clinic attendance among HIV-positive patients, according to the latest study conducted by researchers at Columbia University's Mailman School of Public Health. Findings showed that there was a four-percent higher percentage of patients with viral suppression at HIV care sites that offered financial incentives at care sites compared to sites not offering gift cards. Additionally, there was an approximately five-percent higher viral suppression noted among a subgroup of patients who previously had not shown consistent viral suppression. Findings also indicated that financial incentives did not increase linkage to care.

The results of the study are published online in JAMA Internal Medicine.

The research team, led by Wafaa El-Sadr, MD, MPH, director of ICAP and professor of Epidemiology and Medicine at Columbia University's Mailman School of Public Health, evaluated the effectiveness of financial incentives on linkage to care, defined as the proportion of HIV-positive individuals at the test site linked to care within three months, and viral suppression in HIV-positive patients, defined as the proportion of established patients at HIV care sites with a suppressed viral load less than 400 copies/mL and assessed quarterly.

The financial incentives offered were a $25 coupon redeemable within three months for getting blood drawn for HIV-related tests and $100 for meeting with a clinician and developing a care plan for individuals who tested HIV-positive at a financial incentive test site. HIV-positive patients receiving antiretroviral therapy at a financial incentive care site and engaged in care there received a $70 gift card for suppressed plasma viral load (HIV RNA less than 400 copies/mL) once every three months.

There were 1,061 coupons given out for linkage to care at 18 financial incentive test sites and 39,359 gift cards given to 9,641 HIV-positive patients eligible for them at 17 financial incentive care sites.

The HPTN 065 Study was a community-based clinical trial conducted in the Bronx, New York and Washington, D.C., two communities severely affected by HIV. The study included 37 HIV test sites and 39 HIV care sites, which were randomly assigned to use financial incentives or their standard procedures to enhance linkage to care of HIV-positive patients and viral suppression among those on HIV treatment. The research was conducted by the HIV Prevention Trials Network (HPTN) and funded by the National Institutes of Health.

Achieving viral suppression among HIV-positive persons is critical for their individual health as well as for prevention of HIV transmission to others. This has motivated global efforts to identify all individuals living with HIV, to link them to HIV care, to offer and initiate antiretroviral therapy among such individuals, and to support them to achieve and maintain viral suppression. However, data indicate that only 55 percent of those diagnosed with HIV in the U.S. achieve viral suppression.

"Effective interventions are needed to garner the benefits of antiretroviral therapy for the individual and for society," said Dr. El-Sadr. The results of this study are encouraging and should motivate efforts to pursue the further assessment of using financial incentives in HIV treatment programs and to determine their potential impact when scaled up."