title: A study of financial incentives to reduce plasma HIV RNA among patients in care.
abstract: The role of financial incentives in HIV care is not well studied. We conducted a single-site study of monetary incentives for viral load suppression, using each patient as his own control. The incentive size ($100/quarter) was designed to be cost-neutral, offsetting estimated downstream costs averted through reduced HIV transmission. Feasibility outcomes were clinic workflow, patient acceptability, and patient comprehension. Although the study was not powered for effectiveness, we also analyzed viral load suppression. Of 80 eligible patients, 77 consented, and 69 had 12 month follow-up. Feasibility outcomes showed minimal impact on patient workflow, near-unanimous patient acceptability, and satisfactory patient comprehension. Among individuals with detectable viral loads pre-intervention, the proportion of undetectable viral load tests increased from 57 to 69 % before versus after the intervention. It is feasible to use financial incentives to reward ART adherence, and to specify the incentive by requiring cost-neutrality and targeting biological outcomes.
authors: Department of Medicine, Connecticut VA Healthcare System, West Haven, CT, USA.
authors: Steven
authors: S
authors: Farber
authors: Janet
authors: J
authors: Tate
authors: Cyndi
authors: C
authors: Frank
authors: David
authors: D
authors: Ardito
authors: Michael
authors: M
authors: Kozal
authors: Amy C
authors: AC
authors: Justice
authors: R
authors: R
authors: Scott Braithwaite
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D000328:Adult; D000368:Aged; D000465:Algorithms; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis / Q000191:economics; D005240:Feasibility Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D015497:HIV-1 / Q000235:genetics*; D057220:Health Literacy; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D012367:RNA, Viral / Q000097:blood*; D012959:Socioeconomic Factors; D014040:Token Economy; D019562:Viral Load / Q000187:drug effects* / Q000191:economics
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
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