We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Financial Incentives for Linkage to Care and Viral Suppression Among HIV-Positive Patients: A Randomized Clinical Trial (HPTN 065).
- Authors
El-Sadr, Wafaa M.; Donnell, Deborah; Beauchamp, Geetha; Hall, H. Irene; Torian, Lucia V.; Zingman, Barry; Lum, Garret; Kharfen, Michael; Elion, Richard; Leider, Jason; Gordin, Fred M.; Elharrar, Vanessa; Burns, David; Zerbe, Allison; Gamble, Theresa; Branson, Bernard; HPTN 065 Study Team
- Abstract
<bold>Importance: </bold>Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits.<bold>Objective: </bold>To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients.<bold>Design, Setting, and Participants: </bold>A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, and Washington, DC, to financial incentives or standard of care.<bold>Interventions: </bold>Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed.<bold>Main Outcomes and Measures: </bold>Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System.<bold>Results: </bold>A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95% CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95% CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9% higher (95% CI, 1.4%-8.5%; P = .007) at financial incentive sites. In addition, continuity in care was 8.7% higher (95% CI, 4.2%-13.2%; P < .001) at financial incentive sites.<bold>Conclusions and Relevance: </bold>Financial incentives, as used in this study (HPTN 065), significantly increased viral suppression and regular clinic attendance among HIV-positive patients in care. No effect was noted on linkage to care. Financial incentives offer promise for improving adherence to treatment and viral suppression among HIV-positive patients.<bold>Trial Registration: </bold>clinicaltrials.gov Identifier: NCT01152918.
- Subjects
UNITED States; DIAGNOSIS of HIV infections; HIV infections &; psychology; HIV infections; THERAPEUTICS; ANTI-HIV agents; COMPARATIVE studies; CONTINUUM of care; DRUGS; RESEARCH methodology; MEDICAL cooperation; MEDICAL protocols; MOTIVATION (Psychology); PATIENT compliance; QUALITY assurance; RESEARCH; VIRAL load; EVALUATION research; RANDOMIZED controlled trials; ECONOMICS
- Publication
JAMA Internal Medicine, 2017, Vol 177, Issue 8, p1083
- ISSN
2168-6106
- Publication type
journal article
- DOI
10.1001/jamainternmed.2017.2158