El-Sadr WM, Beauchamp G, Hall IH, Torian LV, Zingman BS, Lum G, Elion RA, Buchacz K, Burns D, Zerbe A, Gamble T, Donnell D, for the HPTN 065 Study Team. Durability of the Effect of Financial Incentives on HIV Viral Load Suppression and Continuity in Care. JAIDS.
Background: Results from the HPTN 065 study showed that financial incentives (FI) were associated with significantly higher viral load suppression and higher levels of engagement in care among patients at HIV care sites randomized to FI versus sites randomized to standard of care (SOC). We assessed HIV viral suppression and continuity in care after intervention withdrawal to determine the durability of FI on these outcomes. Setting: A total of 37 HIV test and 39 HIV care sites in the Bronx, New York and Washington, DC participated in the study. Methods: Laboratory data reported to the US National HIV Surveillance System were used to determine site-level viral suppression and continuity in care outcomes. Post-intervention effects were assessed for the three quarters after discontinuation of FI. Generalized estimation equations (GEE) were used to compare FI and SOC site-level outcomes after intervention withdrawal. Results: After FI withdrawal, a trend remained for an increase in viral suppression by 2.7% (-0.3%, 5.6%, p=0.076) at FI versus SOC sites, decreasing from the 3.8% increase noted during implementation of the intervention. The significant increase in continuity in care during the FI intervention was sustained post-intervention with 7.5% (p=0.007) higher continuity in care at FI versus SOC sites. Conclusion: Following the withdrawal of FI, findings at 9 months post-intervention withdrawal from this large study showed evidence of durable effects of FI on continuity in care, with encouraging trends for continued higher viral suppression. These findings are promising for adoption of such interventions to enhance key HIV-related care outcomes. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.