title: Financial incentives to improve progression through the HIV treatment cascade.
abstract: OBJECTIVE
  We reviewed recent literature on conditional and unconditional financial incentives for their impact on improving movement through the HIV care cascade and HIV prevention.
  
  
  RESULTS
  Concepts from behavioral economics may help improve engagement in HIV care by addressing upstream structural risk factors for HIV, such as poverty, or providing conditional rewards for immediate, measurable outcomes related to HIV care. Incentives have been shown to increase uptake of HIV testing. Yet, few studies to date focus on linkage to care: one large USA-based randomized trial failed to show an effect of incentives; and a smaller trial showed improved linkage to care among drug users, but no difference in virologic suppression. Several small USA-based studies have shown an impact of financial incentives on antiretroviral therapy adherence, but without durability beyond the incentive period. HIV prevention has the most robust evidence for decreasing HIV risk-taking behavior among adolescents and may serve as a model for research on the care cascade.
  
  
  CONCLUSIONS
  Financial incentives show promise for improving engagement in HIV testing, care, and prevention. Understanding the durability, scalability, ease of implementation, and cost-effectiveness of these different approaches will be critical for maximizing the impact of incentives in curtailing the HIV epidemic.
authors.affiliation: aDivision of Infectious Diseases bDivision of General Internal Medicine cMedical Practice Evaluation Center, Massachusetts General Hospital dHarvard Center for AIDS Research, Harvard University, Boston, Massachusetts eGlobal AIDS Program, World Bank, Washington, District of Columbia fDepartment of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
authors.forename: David
authors.initials: D
authors.lastname: Wilson
authors.forename: Jessica
authors.initials: J
authors.lastname: Taaffe
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000379:methods*; D003695:Delivery of Health Care / Q000379:methods* / Q000458:organization & administration; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006302:Health Services Research; D006801:Humans; D009042:Motivation; D014481:United States
chemical_list: D044966:Anti-Retroviral Agents