Financial incentives improve viral suppression among people living with HIV

DURHAM, N.C. – The HPTN 065 study, conducted by the HIV Prevention Trials Network (HPTN), showed that financial incentives can motivate some people living with HIV (PLWH) to take their HIV antiretroviral therapy (ART) medication regularly and maintain viral load suppression. This finding could have implications for improving health outcomes and decreasing the risk of transmitting the virus to others. Study findings were published today in JAMA Internal Medicine.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that 15% of the 1.1 million people in the U.S. living with HIV do not know they have it, and that only 55% of those living with diagnosed HIV are virally suppressed. Enabling people who are unaware of their HIV infection to get tested, engage in care, initiate ART and achieve viral suppression allows them a better chance of living longer, healthier lives and greatly reduces their risk of passing the virus on to their sexual partners.

HPTN 065 evaluated the effect of financial incentives to encourage PLWH to take their ART medication regularly, thereby keeping their viral load suppressed. The study was conducted at 39 care sites across the Bronx, New York and Washington, DC. Half of these sites were randomly assigned to offer financial incentives, while the other half operated according to their normal procedures.

The study found a nearly 4% increase in the number of PLWH with suppressed viral load at care sites offering financial incentives compared to those that did not (standard of care sites). At the peak of the intervention, after financial incentives had been in place for 18 months, the study found an overall increase of 5% in the number of PLWH with a suppressed viral load at sites offering the incentives. Financial incentives also increased how regularly PLWH came for clinic visits. The number of PLWH consistently returning for care was higher by 9% at sites offering financial incentives compared with standard of care sites.

"Even a seemingly modest increase in the percent of people with viral suppression has the potential for considerable clinical and preventive benefits, especially on a population level, as we strive to achieve viral suppression in 90% of PLWH on ART," said Dr. Wafaa El-Sadr, HPTN Principal Investigator and study chair. "Garnering the benefits of HIV treatment for the individual and the community are important priorities and both require achieving high levels of control of HIV."

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About HPTN 065:

HPTN 065 was a large, multi-component study that explored the feasibility of implementing a community-focused strategy to expand HIV testing, diagnose PLWH, and link them to medical care to begin and stay on treatment. This continuum, which begins with HIV testing and ends with viral suppression, is essential for a successful community wide strategy centered on the use of ART for HIV prevention. The study was designed to inform future HIV prevention efforts in the US that aim at utilizing this community-focused approach.

HPTN 065 was funded by the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health and the National Institute on Drug Abuse, all components of the National Institutes of Health (NIH), under award number UM1AI068619. The study was conducted by the NIH-funded HPTN, and implemented in partnership with the CDC and the Departments of Health in New York City and Washington, DC. The contents of the manuscript and press release are solely the responsibility of the authors and does not necessarily represent the official views of the NIH or CDC.

Learn more about HPTN 065 at http://www.hptn.org.

About HPTN:

The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that brings together investigators, ethicists, community and other partners to develop and test the safety and efficacy of interventions designed to prevent the acquisition and transmission of HIV. HPTN studies evaluate new HIV prevention interventions and strategies in populations and geographical regions that bear a disproportionate burden of infection. The HPTN research agenda is focused primarily on the use of integrated strategies: use of antiretroviral drugs (antiretroviral therapy and pre-exposure prophylaxis); interventions for substance abuse, particularly injection drug use; behavioral risk reduction interventions and structural interventions.

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