title: Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India.
abstract: BACKGROUND
  Drug users (DUs), a population that accounts for some of the fastest-growing human immunodeficiency virus (HIV) epidemics globally, lag behind other populations with regard to HIV-related outcomes. We evaluated the role of voucher incentives on linkage and retention in care among DUs in India.
  
  
  METHODS
  In this randomized clinical trial, 120 DUs who were aged ≥18 years, HIV-infected, antiretroviral therapy (ART) naive, and ART eligible and who reported drug use in the prior month were randomized to incentive (INC) or control (CTL) conditions for 12 months. Participants randomized to the INC arm received incentives (redeemable for food/household goods) ranging in value from USD4 to USD8 for achieving prespecified targets (eg, ART initiation, visits to ART center). Subjects in the CTL group could win vouchers in prize-bowl drawings, but HIV care behaviors were not incentivized. The primary endpoint was time to ART initiation.
  
  
  RESULTS
  Sixty participants each were randomized to the INC and CTL arms between December 2009 and September 2010. Participants in the INC arm were more likely to visit the government ART center (49 vs 33; P = .002); 27 participants in the INC and 16 participants in the CTL arm initiated ART (P = .04; hazard ratio for ART = 2.33 [95% confidence interval, 1.15-4.73]). Participants in the INC arm also had significantly more visits to the ART center (median number of visits, 8 vs 3.5; P = .005). However, no difference in viral suppression was observed.
  
  
  CONCLUSIONS
  Modest voucher incentives improved linkage to and retention in HIV care, but did not significantly impact viral suppression among DUs in India, a disenfranchised and difficult-to-treat population.
  
  
  BACKGROUND
  NCT01031745.
authors.affiliation: Johns Hopkins University School of Medicine Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Sunil Suhas
authors.initials: SS
authors.lastname: Solomon
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Aylur K
authors.initials: AK
authors.lastname: Srikrishnan
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Canjeevaram K
authors.initials: CK
authors.lastname: Vasudevan
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Santhanam
authors.initials: S
authors.lastname: Anand
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Muniratnam Suresh
authors.initials: MS
authors.lastname: Kumar
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Pachamuthu
authors.initials: P
authors.lastname: Balakrishnan
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.affiliation: YR Gaitonde Centre for AIDS Research and Education, Chennai, India.
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.affiliation: Johns Hopkins University School of Medicine.
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D055030:Drug Users; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007194:India; D008297:Male; D055118:Medication Adherence; D009042:Motivation; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; India; contingency management; drug users; linkage to care