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Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial
Matthew D Novak1, August F Holtyn1, Forrest Toegel1
1Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA.
AIDS and Behavior
|December 20, 2023
Summary
Financial incentives significantly improved viral suppression in people with HIV. However, this effect diminished once incentives ended, suggesting sustained motivation is key for long-term viral load management.
Area of Science:
- Public Health
- Infectious Diseases
- Behavioral Economics
Background:
- Viral suppression in people living with HIV (PLWH) is crucial for improving quality of life and controlling the HIV/AIDS epidemic.
- Effective interventions to promote sustained HIV viral suppression remain limited.
Purpose of the Study:
- To evaluate the long-term effectiveness of financial incentives in achieving and maintaining viral suppression among PLWH.
Main Methods:
- A randomized controlled trial assigned 102 participants with detectable HIV viral load to either Usual Care or an Incentive group.
- Incentive participants received up to $10 daily for providing blood samples demonstrating undetectable or reduced viral load over 2 years.
- Viral load measurements were compared between groups throughout the intervention period.
Main Results:
- The Incentive group showed a significantly higher percentage of suppressed viral load samples (70%) compared to the Usual Care group (43%) during the 2-year intervention (OR=7.1, p<.001).
- The positive effect on viral suppression was not sustained after the financial incentives were discontinued.
Conclusions:
- Frequent, large-magnitude financial incentives can lead to significant and substantial improvements in viral load for PLWH.
- Sustained financial incentives may be necessary to maintain long-term viral suppression benefits.
- Further research is needed to explore sustainable strategies for long-term viral load management in HIV care.
