CROI 2015 A large-scale program offering HIV-positive people financial incentives to get into medical care and to maintain a fully suppressed virus has failed overall. However, these incentives did lead to modest improvements in the rates of viral suppression and of those who regularly attended check-ups in some settings. This silver lining offers hope that future incentive programs may help achieve a treatment-as-prevention goal, since research shows that having an undetectable viral load vastly lowers a person’s risk of transmitting the virus to others.

Researchers from the HPTN 065 study, a financial incentive program to improve linkage into care following an HIV diagnosis and to improve viral suppression rates among those on antiretrovirals (ARVs), presented their findings at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle.

Thirty-seven HIV testing sites in the Bronx, New York (18 sites), and Washington, DC (19), and 39 HIV care clinics (20 in the Bronx, 19 in Washington) were randomized to either offer financial incentives or maintain a standard of care without them. At the testing sites that offered incentives, people who tested HIV positive were given coupons redeemable for $125 if their first two visits for HIV-related medical care took place within three months. The care sites offering incentives gave people taking antiretrovirals (ARVs) a $70 gift card if the viral load test they were scheduled to take every three months showed their virus was totally suppressed.

The analysis of the program included 1,346 participants pooled from 15 hospitals and 19 community sites. The incentives did not significantly increase the participants’ rates of linkage into health care, nor did they improve the overall rates of viral suppression of those on ARVs. However, those receiving care at hospital clinics were 5.2 percent more likely to have a fully suppressed viral load. Additionally, those in care at sites that had fewer than 185 or fewer patients were 9.6 percent more likely to be virally suppressed, and those at sites with less than 65 percent of their patients virally suppressed at the study’s outset were 10.4 percent more likely to achieve this goal thanks to the incentives.

The incentives also led to an 8.1 percent increase in the rate of “continuity of care,” among the treated population—defined as attending four of their last five clinic appointments, which are scheduled every three months. Clinics with fewer than 185 or fewer patients saw their continuity of care rate increase 18.9 percent, while the increase in the rate for hospital-based clinics was 6.5 percent (which was barely statistically significant in this case), and 10.7 percent at community clinics.

To read the conference abstract, click here.

Editor’s Note: This article has been updated with more current data.