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Cited by 127HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHealthcare Policy and Management

Financial Incentives for Linkage to Care and Viral Suppression Among HIV-Positive Patients: A Randomized Clinical Trial (HPTN 065)

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El-Sadr, Wafaa M., Donnell, Deborah, Beauchamp, Geetha, Hall, H. Irene, Torian, Lucia V., Zingman, Barry, Lum, Garret, Kharfen, Michael +9 more·2017·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2017.2158PMC PMC5604092
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Abstract

Importance: 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. Objective: To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. Design, Setting, and Participants: 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. Interventions: 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. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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. Trial Registration: clinicaltrials.gov Identifier: NCT01152918.

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Authors
El-Sadr, W. M., Donnell, D., Beauchamp, G., Hall, H. I., Torian, L. V., Zingman, B., Lum, G., Kharfen, M., Elion, R., Leider, J., Gordin, F. M., Elharrar, V., Burns, D., Zerbe, A., Gamble, T., Branson, B., & for the HPTN 065 Study Team
Affiliations
  • Columbia University (US)
  • Fred Hutch Cancer Center (US)
  • Centers for Disease Control and Prevention (US)
  • New York City Department of Health and Mental Hygiene (US)
  • Albert Einstein College of Medicine (US)
  • District of Columbia Department of Health (US)
  • George Washington University (US)
  • Washington DC VA Medical Center (US)
  • National Institutes of Health (US)
  • Family Health International 360 (US)
  • Scientific Affairs LLC, Atlanta, Georgia
Corresponding author
El-Sadr, Wafaa M.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2017-08-01
Volume
177
Issue
8
Pages
1083
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2017.2158
PMC
PMC5604092
OpenAlex
W2626716901
Cited by
127
References
32
Citations by year
2026: 3 · 2025: 7 · 2024: 15 · 2023: 9 · 2022: 18 · 2021: 18 · 2020: 18 · 2019: 20 · 2018: 12 · 2017: 7
FWCI
12.00
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • JAMA Internal Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
financial incentives, linkage to care, viral suppression, HIV, antiretroviral therapy, HIV care continuum, continuity of care, HIV testing, gift cards, HIV prevention, HIV prevention in pregnant women
MeSH terms
Adult, Continuity of Patient Care, Female, Humans, Male, Motivation, Patient Care Planning, United States, HIV Infections, Anti-HIV Agents, Viral Load, Medication Adherence, Quality Improvement

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