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. 2024 May 17;16(5):800.
doi: 10.3390/v16050800.

Evaluation of a Project Integrating Financial Incentives into a Hepatitis C Testing and Treatment Model of Care at a Sexual Health Service in Cairns, Australia, 2020-2021

Joshua Dawe  1 , Carla Gorton  2 , Rhondda Lewis  2 , Jacqueline A Richmond  1 , Anna L Wilkinson  1   3   4 , Alisa Pedrana  1   3 , Mark Stoové  1   3   5 , Joseph S Doyle  1   6 , Darren Russell  2   7
Affiliations

Evaluation of a Project Integrating Financial Incentives into a Hepatitis C Testing and Treatment Model of Care at a Sexual Health Service in Cairns, Australia, 2020-2021

Joshua Dawe et al. Viruses. .

Abstract

Background: Understanding the effectiveness of novel models of care in community-based settings is critical to achieving hepatitis C elimination. We conducted an evaluation of a hepatitis C model of care with financial incentives that aimed to improve engagement across the hepatitis C cascade of care at a sexual health service in Cairns, Australia.

Methods: Between March 2020 and May 2021, financial incentives were embedded into an established person-centred hepatitis C model of care at Cairns Sexual Health Service. Clients of the Service who self-reported experiences of injecting drugs were offered an AUD 20 cash incentive for hepatitis C testing, treatment initiation, treatment completion, and test for cure. Descriptive statistics were used to describe retention in hepatitis C care in the incentivised model. They were compared to the standard of care offered in the 11 months prior to intervention.

Results: A total of 121 clients received financial incentives for hepatitis C testing (antibody or RNA). Twenty-eight clients were hepatitis C RNA positive, of whom 92% (24/28) commenced treatment, 75% (21/28) completed treatment, and 68% (19/28) achieved a sustained virological response (SVR). There were improvements in the proportion of clients diagnosed with hepatitis C who commenced treatment (86% vs. 75%), completed treatment (75% vs. 40%), and achieved SVR (68% vs. 17%) compared to the pre-intervention comparison period.

Conclusions: In this study, financial incentives improved engagement and retention in hepatitis C care for people who inject drugs in a model of care that incorporated a person-centred and flexible approach.

Keywords: financial incentives; hepatitis C; people who inject drugs; primary care.

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Conflict of interest statement

Joe Doyle’s institution has received investigator-initiated research funding from Gilead Science, AbbVie, Merck and Bristol Myers Squibb, and consultancy funding from Gilead, Abbvie, and Merck. Alisa Pedrana’s institution has received investigator-initiated research funding from Gilead Science, AbbVie, Merck has consultancy and speaker fees from Gilead. All other authors have no competing interests.

Figures

Figure 1
Figure 1
Flow diagram describing Cairns Sexual Health Service model of care with incentive payments a. a Shaded boxes represent the points at which financial incentives were offered.
Figure 2
Figure 2
Hepatitis C cascade of care among people who received a financial incentive for hepatitis C testing at the Cairns Sexual Health Service a, (N = 121). a Number of people in the previous stage of cascade of care is denominator in percentages. b Number of clients who received a hepatitis C test (antibody or RNA). c Fifty-four clients were known to be hepatitis C antibody positive and initially received a hepatitis C RNA test.
Figure 3
Figure 3
Comparison of hepatitis C treatment outcomes among clients who received a positive hepatitis C RNA test before and after the introduction of financial incentives a,b, (n = 46). a Number of clients diagnosed with chronic hepatitis C is denominator in percentages. b Bars represent 95% confidence intervals for proportions.
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References

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