Financial Incentives Boost Adherence to HIV Antiretrovirals

Providing gift cards observed to increase viral suppression among HIV-positive patients.

Medication adherence is crucial to treatment success and to prevent disease-related complications. For patients with chronic conditions, such as HIV, daily treatment can present a challenge.

In a new study published by JAMA International Medicine, the use of gift cards was observed to increase viral suppression and clinic attendance among patients with HIV. These results suggest that financial incentives can be used to ensure that patients adhere to treatment guidelines and prevent adverse events, including hospitalization.

The investigators evaluated the efficacy of financial incentives on linkage to care, which is defined as the number of patients linked to care within 3 months. The authors additionally looked at the proportion of virally suppressed patients, which includes those with a suppressed viral load less than 400 copies/mL.

Included in the study were patients in the Bronx, NY, and Washington, DC, which both have a high HIV-positive population. Overall, 37 HIV test sites and 39 care sites were randomized to use financial incentives or standard procedure to increase linkage to care and viral suppression.

Patients were offered a $25 coupon for getting HIV blood tests and $100 for meeting with physicians or developing a care plan for newly-diagnosed patients, according to the study. Patients on antiretroviral therapy also received a $70 gift card for achieving viral suppression.

The authors reported that 1061 coupons were given to patients for linkage to care and 39,359 gift cards were given to 9641 HIV-positive patients, according to the study.

The investigators found that 4% more patients achieved viral suppression at the care sites that offered financial incentives compared with the other sites. Patients treated at sites with financial incentives achieved 5% higher viral suppression among a subgroup of patients who previously had not shown consistent suppression, according to the study.

However, the authors noted that the financial incentives were not observed to increase linkage to care, suggesting that other methods may be necessary.

Achieving viral suppression is critical for the prevention of adverse events and HIV transmission. This has led to public health initiatives to diagnose patients with HIV and link them to the proper care, including drug therapy and support, according to the study.

However, with only 55% of patients with HIV achieving viral suppression, it is clear that additional incentives are necessary. These results suggest that providing financial incentives may be a beneficial way to reduce future costs.

"Effective interventions are needed to garner the benefits of antiretroviral therapy for the individual and for society," said researcher Wafaa El-Sadr, MD, MPH. “The results of this study are encouraging and should motivate efforts to pursue the further assessment of using financial incentives in HIV treatment programs and to determine their potential impact when scaled up."