Using Financial Incentives to Improve Rates of Viral Suppression and Engagement in Care of Patients Receiving HIV Care at 3 Health Clinics in Louisiana: The Health Models Program, 2013-2016

Abstract

Objectives: The Care and Prevention in the United States Demonstration Project aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states. We evaluated Health Models, a pay-for-performance program piloted by the Louisiana Department of Health that used financial incentives to improve rates of engagement in HIV medical care and viral suppression among people with HIV. Methods: We enrolled 2076 patients of 3 urban HIV specialty clinics in Louisiana in the Health Models pay-for-performance program on a rolling basis from September 2013 through September 2016 and gave patients cash incentives to attend HIV medical appointments, achieve or maintain viral suppression, and link to supportive services. We used laboratory data collected from Louisiana's HIV surveillance database to calculate rates of engagement in care and viral suppression during the first 24 months of enrollment. Results: Of the 2076 patients who enrolled, 1400 (67.4%) were non-Hispanic black, 1480 (71.3%) were male, 1175 (56.6%) were men who have sex with men, and 1371 (66.0%) reported an annual income of <$15 000. At enrollment, 1456 (70.1%) patients were engaged in HIV care, and 1197 (57.7%) patients were virally suppressed. After 12 months of enrollment, 1474 of 1783 (82.7%) patients were virally suppressed. Of enrolled patients with at least 12 or 24 months of follow-up data, 1299 of 1317 (98.6%) patients were engaged in care during their first 12 months of enrollment, and 995 of 1033 (96.3%) patients were engaged in care between 12 and 24 months of enrollment. Conclusions: During the implementation of Health Models, enrolled patients had increases in rates of viral suppression and achieved rates of engagement in care and viral suppression that were higher than national levels; however, additional supportive services may be needed to further reduce socioeconomic disparities in the rates of viral suppression.

Cross-site Monitoring and Evaluation of the Care and Prevention in the United States Demonstration Project, 2012-2016: Selected Process and Short-term Outcomes

“…CAPUS provides a model that may be useful for other state and local health departments that aim to address HIV-related racial/ethnic disparities in their jurisdictions. Although our cross-site analysis did not permit us to determine the impact on the incidence of HIV or viral suppression, the short-term outcomes and additional findings reported by grantees 25,26 and observed in other similar projects [27][28][29] suggest that CAPUS could potentially have these desired long-term effects, particularly among racial/ethnic minority groups.…”

“…Although cross-site monitoring and evaluation data on the outcomes of grantees’ initiatives to address HIV-related social and structural factors were not collected, some grantee-specific local evaluations 25,26 suggest that improved availability, accessibility, or acceptability of HIV prevention and care services among racial/ethnic minority groups can be attributed, in part, to efforts to address these factors during the project. CAPUS allowed the delivery of comprehensive services along the HIV care continuum in a manner similar to HIV medical homes, which are designed to address the challenges of fragmented care systems and the complexity and social contexts of HIV.…”

Interventions to increase appointment attendance in safety net health centers: A systematic review and meta‐analysis

“…Zhao et al compared appointment attendance between two groups: one group of patients received phone calls, text messages and mailed letters to remind them about scheduled appointments; another group received a voucher stating the monetary value of their next appointment (although services were provided without cost), watched information videos about the importance of their scheduled appointment, and had their appointments scheduled within a 4‐week period from their initial request date 40 . Two multi‐strategy interventions targeted patients with a history of no‐showing 41,42 . DuMontier et al designed an intervention package that included education about the impact of no‐shows on clinic workflow and patients' health, double‐booking patients who had no‐showed, and same‐day appointment access 41 .…”

“…DuMontier et al designed an intervention package that included education about the impact of no‐shows on clinic workflow and patients' health, double‐booking patients who had no‐showed, and same‐day appointment access 41 . Brantley et al financially incentivized appointment attendance and provided patient navigation services that included health education, appointment and treatment adherence counselling 42 …”

Learning by Doing: Lessons From the Care and Prevention in the United States Demonstration Project

“…One grantee that implemented an incentive-based strategy shown to be effective for improving engagement and retention in HIV medical care reported that patients used their financial incentives to pay for transportation, housing, and medication costs not covered by insurance (ie, poverty-related barriers to participation in HIV care). 28…”