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Randomized Controlled Trial
. 2019 Sep;23(9):2337-2346.
doi: 10.1007/s10461-019-02592-8.

Incentives for Viral Suppression in People Living with HIV: A Randomized Clinical Trial

Kenneth Silverman  1 , August F Holtyn  2 , Andrew M Rodewald  2 , Robert F Siliciano  3 , Brantley P Jarvis  2   4 , Shrinidhi Subramaniam  2   5 , Jeannie-Marie Leoutsakos  2 , Carol-Ann Getty  2   6 , Sebastian Ruhs  7 , Mark A Marzinke  8 , Michael Fingerhood  3
Affiliations
Randomized Controlled Trial

Incentives for Viral Suppression in People Living with HIV: A Randomized Clinical Trial

Kenneth Silverman et al. AIDS Behav. 2019 Sep.

Abstract
in English, Undetermined language

The HIV/AIDS epidemic can be eliminated if 73% of people living with HIV take antiretroviral medications and achieve undetectable viral loads. This study assessed the effects of financial incentives in suppressing viral load. People living with HIV with detectable viral loads (N = 102) were randomly assigned to Usual Care or Incentive groups. Incentive participants earned up to $10 per day for 2 years for providing blood samples that showed either reduced or undetectable viral loads. This report presents data on the 1st year after random assignment. Incentive participants provided more (adjusted OR = 15.6, CI 4.2-58.8, p < 0.001) blood samples at 3-month assessments with undetectable viral load (72.1%) than usual care control participants (39.0%). We collected most blood samples. The study showed that incentives can substantially increase undetectable viral loads in people living with HIV. Financial incentives for suppressed viral loads could contribute to the eradication of the HIV/AIDS epidemic.

La epidemia de VIH/SIDA podría ser eliminada si el 73% de las personas que viven con VIH tomaran medicamentos antirretrovirales y lograran mantener la carga viral indetectable. Este estudio evaluó el efecto de incentivos económicos sobre la supresión de la carga viral. Personas que viven con VIH cuyas cargas virales estaban detectables (N = 102) fueron asignadas aleatoriamente a recibir atención de rutina o incentivos. Los participantes en el grupo de incentivos podían recibir hasta $10 por día durante dos años si sus muestras de sangre demostaban que la carga viral se había reducido o estaba indetectable. Este informe presenta datos sobre el primer año después de la asignación al azar. Los participantes en el grupo de incentivos proporcionaron más (proporción de probablidades ajustadas = 15.6, CI 4.2–58.8, p < 0.001) muestras cada tres meses con cargas virales indetectables (72.1%) que los participantes que recibieron cuidados de rutina (39.0%). Hemos recolectado la mayoría de las muestras de sangre. El estudio demostró que los incentivos pueden aumentar sustancialmente las cargas virales indetectables en personas que viven con VIH. Los incentivos económicos por mantener la carga viral suprimida podrían contribuir a la erradicación del VIH/SIDA.

Keywords: ART; Antiretroviral medication adherence; HIV; Incentives; Viral suppression.

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Conflict of interest statement

Conflict of Interest The authors declare no conflicts of interests.

Figures

Fig. 1
Fig. 1
Participant flow diagram through the study.
Fig. 2
Fig. 2
Percentage of blood samples with undetectable (<200 copies/mL) viral load. Dots represent data for individual participants and bars represent group means. Missing samples were considered detectable. Data are from blood samples collected every 3 months from all participants for the first year after random assignment (93.8% of all blood samples from the Incentive participants and 94.0% of all blood samples from Usual Care participants were collected). The difference between groups was statistically significant (Odds Ratio = 15.6; 95% CI = 4.2–58.8; P<0.001).
Fig. 3
Fig. 3
Consecutive viral load results for all blood samples collected at 3-month assessments from Usual Care (left panel) and Incentive (right panel) participants. Within each panel, each row of points represents data for the 3-, 6-, 9-, and 12-month assessment time points for a participant. Solid and open squares represent blood samples with undetectable (<200 copies/mL) and detectable viral loads, respectively. Blank spaces indicate missed samples and deceased individuals are represented by a “d.” Within each panel, participants are arranged from those showing the most blood samples with undetectable viral loads at the top to those with the fewest blood samples with undetectable viral loads at the bottom. The difference between groups was statistically significant (Odds Ratio = 15.6; 95% CI = 4.2–58.8; P<0.001).
See this image and copyright information in PMC

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