Financial incentives to improve progression through the HIV treatment cascade

Bassett, Ingrid V.; Wilson, David; Taaffe, Jessica; Freedberg, Kenneth A.

doi:10.1097/coh.0000000000000196

Cited by 94 publications

(95 citation statements)

References 33 publications

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“…Studies of interventions to improve retention in care and VS in these patients have had limited efficacy, and a recent study using patient navigators and contingency management failed to improve viral suppression 6 months after the intervention ended [35]. While the durability of financial incentives for HIV care is unclear, the cost of treatment of 1 TB case has been estimated to be US $34 600, and risk of TB recurrence could justify their use [36, 37]. Innovative strategies tailored to local populations are needed to improve the HIV care continuum.…”

Section: Discussionmentioning

confidence: 99%

Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA

Schechter

Bizune

Kagei

et al. 2018

Open Forum Infectious Diseases

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BackgroundAntiretroviral therapy (ART) for persons with HIV infection prevents tuberculosis (TB) disease. Additionally, sequential ART after initiation of TB treatment improves outcomes. We examined ART use, retention in care, and viral suppression (VS) before, during, and 3 years following TB treatment for an inner-city cohort in the United States.MethodsRetrospective cohort study among persons treated for culture-confirmed TB between 2008 and 2015 at an inner-city hospital.ResultsAmong 274 persons with culture-confirmed TB, 96 (35%) had HIV co-infection, including 23 (24%) new HIV diagnoses and 73 (76%) previous diagnoses. Among those with known HIV prior to TB, the median time of known HIV was 6 years, and only 10 (14%) were on ART at the time of TB diagnosis. The median CD4 at TB diagnosis was 87 cells/uL. Seventy-four (81%) patients received ART during treatment for TB, and 47 (52%) has VS at the end of TB treatment. Only 32% of patients had continuous VS 3 years after completing TB treatment. There were 3 TB recurrences and 3 deaths post–TB treatment; none of these patients had retention or VS after TB treatment.ConclusionsAmong persons with active TB co-infected with HIV, we found that the majority had known HIV and were not on ART prior to TB diagnosis, and retention in care and VS post–TB treatment were very low. Strengthening the HIV care continuum is needed to improve HIV outcomes and further reduce rates of active TB/HIV co-infection in our and similar settings.

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Section: Discussionmentioning

confidence: 99%

Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA

Schechter

Bizune

Kagei

et al. 2018

Open Forum Infectious Diseases

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“…These findings suggest the need for additional evaluation of incentive types and delivery methods that would be more acceptable to PLWH, such as tiered incentives which provide greater rewards over time. 24 …”

Section: Discussionmentioning

confidence: 99%

Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique

Sutton

Lahuerta

Abacassamo³

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited.Methods:The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions—modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders—and 3 structural interventions—point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered—extent each intervention was delivered as planned—and dose received—participant acceptability—of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data.Results:For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention.Discussion:Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.

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“…Bassett et al (2015), recently reviewed other studies that have attempted to improve progression through the HIV treatment cascade using CM approaches. They.…”

Section: Significance and Future Directionsmentioning

confidence: 99%

“…A challenge facing the behavioral health community, then, is to devise and investigate CM interventions that can effectively promote sequences of behavior leading to an ultimate desirable health outcome, a goal that has infrequently been pursued to date (Bassett, Wilson, Taaffe, & Freedberg, 2015). A recently completed multi-site CTN study, project HOPE (CTN 0049, Hospital Visit as Opportunity for Prevention and Engagement for HIV-Infected Drug Users), provided the opportunity to develop a novel contingency management intervention designed to aid in the accomplishment of a long-term health goal, namely viral suppression among HIV positive substance users.…”

Section: Introductionmentioning

confidence: 99%

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users

Stitzer

Calsyn

Matheson

et al. 2017

Journal of Substance Abuse Treatment

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Contingency management (CM) interventions generally target a single behavior such as attendance or drug use. However, disease outcomes are mediated by complex chains of both healthy and interfering behaviors enacted over extended periods of time. This paper describes a novel multi-target contingency management (CM) program developed for use with HIV positive substance users enrolled in a CTN multi-site study (0049 Project HOPE). Participants were randomly assigned to usual care (referral to health care and SUD treatment) or 6-months strength-based patient navigation interventions with (PN + CM) or without (PN only) the CM program. Primary outcome of the trial was viral load suppression at 12-months post-randomization. Up to $1160 could be earned over 6 months under escalating schedules of reinforcement. Earnings were divided among eight CM targets; two PN-related (PN visits; paperwork completion; 26% of possible earnings), four health-related (HIV care visits, lab blood draw visits, medication check, viral load suppression; 47% of possible earnings) and two drug-use abatement (treatment entry; submission of drug negative UAs; 27% of earnings). The paper describes rationale for selection of targets, pay amounts and pay schedules. The CM program was compatible with and fully integrated into the PN intervention. The study design will allow comparison of behavioral and health outcomes for participants receiving PN with and without CM; results will inform future multi-target CM development.

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Financial incentives to improve progression through the HIV treatment cascade

Cited by 94 publications

References 33 publications

Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA

Challenges Across the HIV Care Continuum for Patients With HIV/TB Co-infection in Atlanta, GA

Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique

Development of a Multi-Target Contingency Management Intervention for HIV Positive Substance Users

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