Yale University

A study of financial incentives to reduce plasma HIV RNA among patients in care.

TitleA study of financial incentives to reduce plasma HIV RNA among patients in care.
Publication TypeJournal Article
Year of Publication2013
AuthorsFarber, Steven, Janet Tate, Cyndi Frank, David Ardito, Michael Kozal, Amy C. Justice, and R. Scott Braithwaite
JournalAIDS and behavior
Date Published2013 Sep
KeywordsAcquired Immunodeficiency Syndrome, Adult, Aged, Algorithms, Anti-HIV Agents, Cost-Benefit Analysis, Feasibility Studies, Health Literacy, HIV Infections, HIV-1, Humans, Male, Medication Adherence, Middle Aged, Motivation, RNA, Viral, Socioeconomic Factors, Token Economy, Viral Load
AbstractThe role of financial incentives in HIV care is not well studied. We conducted a single-site study of monetary incentives for viral load suppression, using each patient as his own control. The incentive size ($100/quarter) was designed to be cost-neutral, offsetting estimated downstream costs averted through reduced HIV transmission. Feasibility outcomes were clinic workflow, patient acceptability, and patient comprehension. Although the study was not powered for effectiveness, we also analyzed viral load suppression. Of 80 eligible patients, 77 consented, and 69 had 12 month follow-up. Feasibility outcomes showed minimal impact on patient workflow, near-unanimous patient acceptability, and satisfactory patient comprehension. Among individuals with detectable viral loads pre-intervention, the proportion of undetectable viral load tests increased from 57 to 69 % before versus after the intervention. It is feasible to use financial incentives to reward ART adherence, and to specify the incentive by requiring cost-neutrality and targeting biological outcomes.
Alternate JournalAIDS Behav

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