Incentives for Viral Suppression in People Living with HIV: A Randomized Clinical Trial

mMotiv8: A smartphone‐based contingency management intervention to promote smoking cessation

“…The present study addressed the initial feasibility of a prompt reduction schedule and showed that most participants who initiated abstinence qualified for the reduction in prompt frequency. Silverman et al (2019) used a similar reduction procedure over 1 year to monitor blood tests to measure viral load in a CM intervention to decrease viral load in individuals who were HIV positive. The authors found that the schedule was feasible, and they were able to collect most blood samples (over 90%).…”

“…The prompts were sent within a prespecified 12‐hr time window, and they varied within this time window from day to day. In addition, we used a monitoring schedule that decreased in frequency from twice per day to once per day if the participant was continually abstinent for 3 weeks (Silverman et al, 2019). The ultimate goal of reducing the frequency is to permit a low frequency, long‐term maintenance schedule that would not be burdensome to participants (Silverman et al, 2019).…”

Are Financial Incentives Appropriate Means of Encouraging Medication Adherence Among People Living With HIV?

“…Financial incentives have been shown to be an effective intervention to boost antiretroviral (ARV) adherence among people living with HIV (PWH). 1,2,3,4,5 Examining the effects of combining intensive case management services to maintain adherence with financial incentives ($100 gift voucher for viral load < 50c/ml at quarterly assays), Ghose et al found that the Undetectables Intervention (UI) significantly improved ARV adherence and maintained it over a 4-year period in a sample of socially vulnerable PWH with a high prevalence of homelessness, substance use, and mental illness. 6 Despite the proven effectiveness of paying participants to maintain medication adherence and achieve wellness goals, the ethics of financial incentives have been debated.…”

Abstinence-reinforcing contingency management improves HIV viral load suppression among HIV-infected people who use drugs: A randomized controlled trial

“…Abstinence-reinforcing contingency management (CM) (financial incentives contingent on drug-free urine) leads to reduction in illicit opioid and cocaine use (Giuffrida and Torgerson, 1997;Griffith et al, 2000;Higgins et al, 2000;Lussier et al, 2006;Prendergast et al, 2006;Preston et al, 2000Preston et al, , 2002Schottenfeld et al, 2005;Silverman et al, 1996aSilverman et al, , 1996bSilverman et al, , 1998Silverman et al, , 2004. Due to the success of abstinence-reinforcing CM, other studies have used CM to optimize HIV outcomes (Bassett et al, 2015;El-Sadr et al, 2017;Farber et al, 2013;Metsch et al, 2016;Rigsby et al, 2000;Rosen et al, 2007;Silverman et al, 2019;Solomon et al, 2014;Sorensen et al, 2007). Of seven randomized trials that tested the effect of CM interventions on HIV outcomes, three reinforced ARV adherence (Rigsby et al, 2000;Rosen et al, 2007;Sorensen et al, 2007), one reinforced VL suppression (Silverman et al, 2019), one reinforced linkage to HIV care and VL suppression (with two separate CM interventions) (El-Sadr et al, 2017), and two reinforced several different behaviors including attending patient navigation sessions, HIV clinic visits, HIV blood tests, ARV initiation, VL suppression, substance use disorder treatment, or drug-free lab tests (Metsch et al, 2016;Solomon et al, 2014).…”

“…Due to the success of abstinence-reinforcing CM, other studies have used CM to optimize HIV outcomes (Bassett et al, 2015;El-Sadr et al, 2017;Farber et al, 2013;Metsch et al, 2016;Rigsby et al, 2000;Rosen et al, 2007;Silverman et al, 2019;Solomon et al, 2014;Sorensen et al, 2007). Of seven randomized trials that tested the effect of CM interventions on HIV outcomes, three reinforced ARV adherence (Rigsby et al, 2000;Rosen et al, 2007;Sorensen et al, 2007), one reinforced VL suppression (Silverman et al, 2019), one reinforced linkage to HIV care and VL suppression (with two separate CM interventions) (El-Sadr et al, 2017), and two reinforced several different behaviors including attending patient navigation sessions, HIV clinic visits, HIV blood tests, ARV initiation, VL suppression, substance use disorder treatment, or drug-free lab tests (Metsch et al, 2016;Solomon et al, 2014). One non-randomized pre-post study also examined a CM intervention that reinforced VL suppression (Farber et al, 2013).…”