WEDNESDAY, June 21, 2017 -- There are mixed results from a new study on the use of monetary rewards to help boost the odds that HIV-infected patients will enter care, and take their meds as directed.
The study, conducted at HIV clinics in New York City and Washington, D.C., found that financial incentives such as gift cards could improve the likelihood that HIV patients would take antiretroviral medications that suppress the AIDS-causing virus.
But the effect was modest in patients already receiving care, and the gift cards had little effect on increasing the number of new HIV-positive patients who got treated, the study authors said.
Still, lead author Dr. Wafaa El-Sadr called the results "encouraging" and said they "should motivate efforts to pursue the further assessment of using financial incentives in HIV treatment programs and to determine their potential impact when scaled up."
El-Sadr is a professor of epidemiology and medicine at Columbia University's Mailman School of Public Health in New York City.
According to her team, suppression of HIV via the consistent use of powerful antiretroviral drugs benefits the health of the patient and reduces the risk of HIV transmission to others.
But keeping patients on track in taking their medications is a problem: Research suggests that only 55 percent of HIV patients in the United States achieve viral suppression.
However, studies in other types of patient groups have shown that sometimes, a little financial reward can help patients stick to their regimens.
So this study -- conducted at 37 HIV test sites and 39 HIV care sites in the Bronx, N.Y., and Washington, D.C. -- offered $70 gift cards to existing patients to help improve their medication adherence and boost rates of viral suppression.
In another experiment, people were offered $25 gift cards to encourage HIV blood tests, and $100 for a meeting with a clinician for those who tested HIV-positive.
The study produced a modest benefit. Overall, the rate of patient viral suppression was about 4 percent higher at the care sites that offered gift cards than at those that followed standard procedures. Also, the care sites that offered gift cards had a 5 percent higher rate of viral suppression among a subgroup of patients who previously had not shown consistent viral suppression.
However, the gift cards had little effect on increasing the number of new HIV-positive patients who began receiving care, El-Sadr's team noted.
And one expert in HIV care wondered how cost-effective such programs might be.
Dr. David Rosenthal directs the Center for Young Adult, Adolescent and Pediatric HIV at Northwell Health in Great Neck, N.Y. He said that "according to the authors, $70 gift cards were given to 39,359 clinic visits, which according to my calculations, has a cost of over $2.7 million dollars."
Rosenthal said that works out to thousands of dollars spent for each of the relatively few patients who benefited, and "it seems very concerning that this may not be the best use of funds to achieve viral suppression."
According to Rosenthal, rather than offering the gift cards to all patients at HIV clinics, different or more targeted approaches might work better.
"Perhaps financial incentives should be provided only to those who are not already virally suppressed, or mobile app-based technology deployed to improve adherence, or funds allocated for dedicated clinic staff to provide intensive adherence follow-up, including home visits with patients," he theorized.
"This study shows that financial incentives work, but probably should not be applied uniformly across a community," Rosenthal said.
The study was published June 19 in the journal JAMA Internal Medicine.