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Small incentives improved linkage to HIV care among drug users
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Offering small voucher incentives improved linkage to and retention in HIV care among drug users in India but did not affect viral suppression, according to researchers from Johns Hopkins University and YR Gaitonde Centre for AIDS Research and Education in Chennai, India.
“Although this pilot [study] failed to detect differences in viral suppression, it demonstrated that modest voucher incentives played a role in modifying health-seeking behaviors by improving linkage and retention in care (essential first steps in the pathway to viral suppression) among HIV-infected drug users in a low- and middle-income country — a population with high disease burden and low ART uptake,” the researchers wrote in Clinical Infectious Diseases.
The study included 120 drug users with HIV who were randomly assigned to the incentive arm or the control arm. All participants did study visits at baseline and at 3, 6, 9 and 12 months. Blood samples were collected at baseline, 6 and 12 months. The participants were referred to a government ART center for treatment.
Participants in the incentive arm were given vouchers for achieving specific targets: attending monthly clinical/medication refill visits, initiating ART and achieving viral suppression. The vouchers could be used for groceries or household items. Although patients in the control arm were not offered vouchers for treatment targets, they were offered opportunities to win vouchers by random drawing at each study visit.
Among the 120 participants, 94 returned for the 12-month visit. More participants in the incentive arm visited a government ART center: 49 vs. 33 in the control arm. Twenty-seven participants in the incentive arm initiated ART vs. 16 participants in the control arm. In a multivariate analysis, receiving the incentives was associated with initiating ART (HR=2.93; 95% CI, 1.39-6.2). However, there were no differences in CD4 count gains or viral suppression between the arms.
“Additional studies will be needed to characterize the steps in the care continuum where incentives may be most beneficial and to develop integrated multi-faceted interventions to engage and retain marginalized populations of HIV-infected person in care,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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