Brief Report: Durability of the Effect of Financial Incentives on HIV Viral Load Suppression and Continuity in Care: HPTN 065 Study

Abstract

Background: Results from the HPTN 065 study showed that financial incentives (FI) were associated with significantly higher viral load suppression and higher levels of engagement in care among patients at HIV care sites randomized to FI versus sites randomized to standard of care (SOC). We assessed HIV viral suppression and continuity in care after intervention withdrawal to determine the durability of FI on these outcomes. Setting: A total of 37 HIV test and 39 HIV care sites in the Bronx, New York, and Washington, DC, participated in the study. Methods: Laboratory data reported to the US National HIV Surveillance System were used to determine site-level viral suppression and continuity in care outcomes. Postintervention effects were assessed for the 3 quarters after discontinuation of FI. Generalized estimation equations were used to compare FI and SOC site-level outcomes after intervention withdrawal. Results: After FI withdrawal, a trend remained for an increase in viral suppression by 2.7% (−0.3%, 5.6%, P = 0.076) at FI versus SOC sites, decreasing from the 3.8% increase noted during implementation of the intervention. The significant increase in continuity in care during the FI intervention was sustained after intervention with 7.5% ( P = 0.007) higher continuity in care at FI versus SOC sites. Conclusions: After the withdrawal of FI, findings at the 9-months postintervention withdrawal from this large study showed evidence of durable effects of FI on continuity in care, with trend for continued higher viral suppression. These findings are promising for adoption of such interventions to enhance key HIV-related care outcomes.

The Utilisation of Payment Models Across the HIV Continuum of Care: Systematic Review of Evidence

“…Of the 23 articles included, 15 (65%) articles reported randomised clinical trials [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], 4 (17%) non-randomised empirical studies [34][35][36][37] and 4 (17%) quantitative descriptive studies with cost-effectiveness analyses [38][39][40][41].…”

“…Only one study analysed the durability of the results following the implementation of the payment model [19]. In this study, a randomised clinical trial [19], the findings from the payment model were sustained 9 months post its implementation.…”

“…As an example, a recent randomised clinical trial by El-Sadr et al (2019) [19] assessed the impact of individual financial incentives in two areas of HIV care: continuity of healthcare (proportion of patients with CD4 + count in 4 of the last 5 quarters); and viral suppression (proportion of patients with a viral load below 400 copies per ml among patients with at least 2 counts in the last 5 quarters). A higher proportion of participants in the intervention group showed greater continuity of health care compared to the control group (7.5%, p = 0.007, t-test) and exhibited a trend towards improved HIV viral suppression (2.7%, p = 0.076, t-test).…”

Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review

“…In one study, patients would receive congratulations for attending the clinic three consecutive on-time visits for HIV care, and they were given a sticker to proudly place on an interactive poster publicly displayed in the clinic to celebrate and acknowledge their achievement [143]. Another study involved a multi-component positive affect intervention for MSM who used drugs, eight core skills, and meditation exercises were delivered to them to increase positive affect among HIV management Use of non-explicit commitment devices in the form of financial incentives for ART adherence and viral load suppression goal in the future [108,144,147,154,[169][170][171][172][173][174][175][176][177][178][179][180][181] Use of non-explicit commitment devices in the form of financial incentives to meet HIV testing, linkage to HIV care and clinic attendance goal in the future [172,182,183] Use of non-explicit commitment devices in the form of non-financial incentives for ART adherence and viral load suppression goal in the future [74,147,155] Use of non-explicit commitment devices in the form of non-financial incentives to meet HIV testing, linkage to HIV care and clinic attendance goal in the future [117,143,146,[184][185][186] Ego HIV prevention HIV education sessions alongside financial education programmes to target ego and self-efficacy [18,31,99,[187][188][189] HIV education sessions and peer support to target ego and increase HIV risk perception ...…”

Promoting antiretroviral therapy adherence habits: a synthesis of economic and psychological theories of habit formation

“…Although many behavioral interventions have been tested for combating these psychological barriers, most fail to produce persistent, high medication adherence beyond the length of the intervention [30][31][32][33][34][35]. Moreover, those interventions that report persistent improvements typically only observe adherence for a few months post-intervention; or they are ungeneralizable, unscalable, or ineffective for the majority of study participants [36][37][38][39]. Thus, novel intervention approaches that can overcome these psychological barriers are needed for improving ART adherence and the associated health outcomes [40][41][42] among the roughly 17% of PLWH in the United States, approximately 189 200 people, who are on ART but are not virally suppressed [43].…”