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. 2018 Nov/Dec;133(2_suppl):75S-86S.
doi: 10.1177/0033354918793096.

Using Financial Incentives to Improve Rates of Viral Suppression and Engagement in Care of Patients Receiving HIV Care at 3 Health Clinics in Louisiana: The Health Models Program, 2013-2016

Antoine D Brantley  1 , Samuel Burgess  1 , Jacquelyn Bickham  1 , Deborah Wendell  1 , DeAnn Gruber  1
Affiliations

Using Financial Incentives to Improve Rates of Viral Suppression and Engagement in Care of Patients Receiving HIV Care at 3 Health Clinics in Louisiana: The Health Models Program, 2013-2016

Antoine D Brantley et al. Public Health Rep. 2018 Nov/Dec.

Abstract

Objectives: The Care and Prevention in the United States Demonstration Project aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states. We evaluated Health Models, a pay-for-performance program piloted by the Louisiana Department of Health that used financial incentives to improve rates of engagement in HIV medical care and viral suppression among people with HIV.

Methods: We enrolled 2076 patients of 3 urban HIV specialty clinics in Louisiana in the Health Models pay-for-performance program on a rolling basis from September 2013 through September 2016 and gave patients cash incentives to attend HIV medical appointments, achieve or maintain viral suppression, and link to supportive services. We used laboratory data collected from Louisiana's HIV surveillance database to calculate rates of engagement in care and viral suppression during the first 24 months of enrollment.

Results: Of the 2076 patients who enrolled, 1400 (67.4%) were non-Hispanic black, 1480 (71.3%) were male, 1175 (56.6%) were men who have sex with men, and 1371 (66.0%) reported an annual income of <$15 000. At enrollment, 1456 (70.1%) patients were engaged in HIV care, and 1197 (57.7%) patients were virally suppressed. After 12 months of enrollment, 1474 of 1783 (82.7%) patients were virally suppressed. Of enrolled patients with at least 12 or 24 months of follow-up data, 1299 of 1317 (98.6%) patients were engaged in care during their first 12 months of enrollment, and 995 of 1033 (96.3%) patients were engaged in care between 12 and 24 months of enrollment.

Conclusions: During the implementation of Health Models, enrolled patients had increases in rates of viral suppression and achieved rates of engagement in care and viral suppression that were higher than national levels; however, additional supportive services may be needed to further reduce socioeconomic disparities in the rates of viral suppression.

Keywords: HIV treatment adherence; incentive; viral suppression.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure.
Figure.
Follow-up outcomes for patients enrolled in the Health Models pay-for-performance program at 3 urban HIV clinics, New Orleans and Baton Rouge, Louisiana, September 2013–September 2016. Health Models is a pay-for-performance program in which HIV medical care patients are given financial incentives to engage in HIV medical care, achieve and maintain viral suppression, and use supportive services referrals. Health Models was part of the Care and Prevention in the United States Demonstration Project, a 4-year cross-agency demonstration project led by the Centers for Disease Control and Prevention with the aim of reducing HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in the United States.
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