Patterns of HIV viral suppression in a clinical trial evaluating a contingency management intervention

The HIV/AIDS epidemic remains a global health challenge. This secondary analysis evaluated time-course effects of a contingency management intervention designed to improve antiretroviral therapy (ART) adherence and sustained HIV viral suppression. Participants were randomized to a usual care or an incentive group. Incentive participants could earn monetary incentives for submitting blood samples with reduced or undetectable HIV viral loads. A thinning procedure gradually reduced testing and reinforcer delivery frequency for participants who consistently met reinforcement criteria. Over the 2-year intervention period, the incentive group demonstrated significantly shorter times to viral suppression and significantly longer durations of sustained suppression and maintained undetectable viral loads even as testing intervals increased. Engagement in the intervention correlated strongly with treatment success. These findings illustrate the potential of adaptive, reinforcement-based strategies to enhance ART adherence, sustain HIV viral suppression, inform scalable interventions for HIV care, and contribute to ending the HIV/AIDS epidemic.