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Financial incentives do not boost HIV viral suppression rate
Financial incentives had no effect on viral suppression among HIV-positive adults in Uganda, according to a recent study. Researchers said these findings suggest a need for better interventions to promote the achievement of viral suppression.
“Antiretroviral therapy (ART) can substantially improve the health of HIV-positive individuals and virtually eliminate the risk of HIV transmission to others. Realizing the benefits of ART requires treatment upon diagnosis of HIV with high and sustained adherence to a regimen that can achieve and maintain viral suppression,” Harsha Thirumurthy, PhD, of the department of medical ethics and health policy, Perelman School of Medicine and Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, and colleagues wrote. “Despite substantial progress in scaling up HIV testing services and ART access in sub-Saharan Africa, about 50% of people living with HIV in the region are not virally suppressed.”
To test if financial incentives, which have been proven effective in previous studies, would benefit this population, researchers conducted a randomized controlled trial, recruiting HIV-positive individuals aged 18 years and older from community health campaigns. Between June 27, 2016, and May 25, 2018, participants were randomly assigned to the financial incentive intervention group or the control group. Researchers measured the patients’ viral load at baseline, 6, 12, 24 and 48 weeks, with participants in the financial incentive group receiving amounts that increased at each visit — from about $4 to $12.50.
According to the study, of the 400 participants, eight withdrew from the study and 35 died or were lost to follow-up. At baseline, 300 participants (77%) were virally suppressed and at 24 weeks, 168 participants (84%) in the intervention group and 156 (82%) in the control group were virally suppressed (OR = 1.14; 95% CI, 0.68-1.93). Based on these results, researchers concluded that financial incentives had no effect on viral suppression.
“Financial incentives offered over a 6-month period had no effect on viral suppression among HIV-positive adults,” the authors wrote. “Provision of viral load results and high baseline viral suppression might have contributed to high viral suppression in both study groups. Our findings highlight the need for more interventions that promote achievement of viral suppression among unsuppressed individuals.” – by Caitlyn Stulpin
Disclosures: The authors report no relevant financial disclosures.