title: "Payment by Results"--financial incentives and motivational interviewing, adherence interventions in young adults with perinatally acquired HIV-1 infection: a pilot program.
abstract: Emerging evidence suggests financial incentives (FIs) improve medication adherence in select populations. A small proportion of adolescents with perinatal HIV (PaHIV) transfer to adult services with established poor adherence and advanced disease. We describe a single center adherence intervention combining FIs with motivational interviewing (MI). Eligible patients (PaHIV,16-25 years, CD4 count ≤ 200, off ART despite multiple attempts) received MI, and FI dependent on viral load (VL) reduction for 1 year. Outcome measures compared CD4 gain from baseline at 1 year and 12 months post cessation of FI/MI. Eleven young people enrolled; median age 19 years, 8 female. Baseline median CD4 count 30 cells/μL (IQR 10-160), VL 12,870 c/mL. Outcomes at 12 months: 9/11 ever achieved VL < 50, 5 sustained undetectable VL, median CD4 140, mean CD4 gain 90 cells/μL at 1 year. Twelve months post cessation of MI/FI; six VL < 50, median CD4 75, mean CD4 gain 122 cells/μL. Total FI expenditure £1,350: £68 per 50 CD4 cells at 1 year, £55 at 24 months. To prevent death, adolescents with PaHIV require novel interventions to reverse poor patterns of adherence established since childhood. FI/MI improved virological and immunological outcomes with minimal expenditure. Extension of this pilot work for vulnerable individuals is now indicated.
authors.affiliation: The 900 Clinic, The Jefferies Wing, Imperial College Healthcare NHS Trust, London, United Kingdom .
authors.forename: Caroline
authors.initials: C
authors.lastname: Foster
authors.forename: Susan
authors.initials: S
authors.lastname: McDonald
authors.forename: Graham
authors.initials: G
authors.lastname: Frize
authors.forename: Sarah
authors.initials: S
authors.lastname: Ayers
authors.forename: Sarah
authors.initials: S
authors.lastname: Fidler
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000523:psychology* / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D062405:Motivational Interviewing / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D012201:Reward; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents