It was in 2011 that Dr. Mark Hull of the British Columbia Centre for Excellence in HIV/AIDS formally proposed the idea of providing financial incentives as a means of retaining HIV patients in care since, in his own words, “any behavior that is reinforced by a reward usually increases in frequency.”The practice, called contingency management (CM) and conditional cash transfers (CCT), has been implemented in number of other public health sectors, including a program in San Francisco for injecting drug users (IDUs), which aimed to increase completion rates of a three-dose hepatitis B vaccination series.
In analyzing the results, researchers at the University of California, San Francisco concluded that the monthly cash incentives increased the rate of completion from 25% to 70%.Soon after, based on this and other pieces of research, the U.K.’s National Institute for Health and Care Excellence (NICE) began recommending the use of vouchers for agencies working with illicit drug users-either to improve abstinence rates in those on methadone treatment or to incentivize testing for HIV, hepatitis B, hepatitis C and tuberculosis.Contingency Management in Patients with HIVOnly recently did investigators begin to look into the effectiveness of CM/CCT in people with HIV. One such study, presented at the 2015 Conference on Retroviruses and Opportunistic Infections (CROI), aimed to assess whether financial incentives, in the form of redeemable gift cards, might
- encourage people in high-risk communities to get tested for HIV;
- encourage HIV-positive individuals to not only access medical care but to remain in care, and;
- increase drug adherence rates to better sustain undetectable HIV viral loads.
The study, called HPTN 065 TLC-Plus (“Testing and Linkage to Care Plus Treatment”) was conducted at 37 HIV testing sites and 39 care centers in Washington, D.C. and the Bronx, New York, both of which have high incidence rates in poorer black and Hispanic neighborhoods. The study was designed so that half the sites would provide financial incentives, while the other half wouldn’t.