Financial incentives for linkage to care and viral suppression among HIV-positive patients a randomized clinical trial (HPTN 065)

Wafaa M. El-Sadr, Deborah Donnell, Geetha Beauchamp, H. Irene Hall, Lucia V. Torian, Barry S. Zingman, Garret Lum, Michael Kharfen, Richard Elion, Jason Leider, Fred M. Gordin, Vanessa Elharrar, David Burns, Allison Zerbe, Theresa Gamble, Bernard Branson, Georgette King, Jonathan Lucas, Brad Ogilive, Ron Simmons & 39 others A. Toni Young, Melissa Turner, June Pollydore, Richard Jefferys, Jeremiah Johnson, Hadiyah Charles, Ruth Concepcion, Candia Richards-Clarke, Yaa Simpson, Morénike Giwa, Charles Martin, Alicia Beatty, Tiffany Brown Dominique, D'Angelo D.Ontace Keyes, Stephaun Wallace, Jennifer Farrior, Elizabeth Greene, Phaedrea Watkins, Andrea Jennings, Jill Stanton, Michelle Robinson, Laura McKinstry, Julie Zhuo, Kate Ostbye, Cory Nathe, Kate Buchacz, Kristen Mahle Gray, Jianmin Li, Baohua Wu, Mi Chen, Benjamin Laffoon, Jim Hughes, Jonathan Mermin, Tom Coates, Jeanne Keruly, Liza Dawson, Dianne Rausch, Estelle Piwowar-Manning, Ying Chen

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

IMPORTANCE Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits. OBJECTIVE To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. DESIGN, SETTING, AND PARTICIPANTS A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, andWashington, DC, to financial incentives or standard of care. INTERVENTIONS Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed. MAIN OUTCOMES AND MEASURES Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System. RESULTS A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95%CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95%CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9%higher (95%CI, 1.4%-8.5%; P = .007) at financial incentive sites. In addition, continuity in care was 8.7%higher (95%CI, 4.2%-13.2%; P < .001) at financial incentive sites. CONCLUSIONS AND RELEVANCE Financial incentives, as used in this study (HPTN 065), significantly increased viral suppression and regular clinic attendance among HIV-positive patients in care. No effect was noted on linkage to care. Financial incentives offer promise for improving adherence to treatment and viral suppression among HIV-positive patients.

Original languageEnglish (US)
Pages (from-to)1083-1092
Number of pages10
JournalJAMA Internal Medicine
Volume177
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Motivation
Randomized Controlled Trials
HIV
Gift Giving
Continuity of Patient Care
Standard of Care
Viral Load
Patient Care
Odds Ratio

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Financial incentives for linkage to care and viral suppression among HIV-positive patients a randomized clinical trial (HPTN 065). / El-Sadr, Wafaa M.; Donnell, Deborah; Beauchamp, Geetha; Irene Hall, H.; Torian, Lucia V.; Zingman, Barry S.; Lum, Garret; Kharfen, Michael; Elion, Richard; Leider, Jason; Gordin, Fred M.; Elharrar, Vanessa; Burns, David; Zerbe, Allison; Gamble, Theresa; Branson, Bernard; King, Georgette; Lucas, Jonathan; Ogilive, Brad; Simmons, Ron; Toni Young, A.; Turner, Melissa; Pollydore, June; Jefferys, Richard; Johnson, Jeremiah; Charles, Hadiyah; Concepcion, Ruth; Richards-Clarke, Candia; Simpson, Yaa; Giwa, Morénike; Martin, Charles; Beatty, Alicia; Dominique, Tiffany Brown; Keyes, D'Angelo D.Ontace; Wallace, Stephaun; Farrior, Jennifer; Greene, Elizabeth; Watkins, Phaedrea; Jennings, Andrea; Stanton, Jill; Robinson, Michelle; McKinstry, Laura; Zhuo, Julie; Ostbye, Kate; Nathe, Cory; Buchacz, Kate; Gray, Kristen Mahle; Li, Jianmin; Wu, Baohua; Chen, Mi; Laffoon, Benjamin; Hughes, Jim; Mermin, Jonathan; Coates, Tom; Keruly, Jeanne; Dawson, Liza; Rausch, Dianne; Piwowar-Manning, Estelle; Chen, Ying.

In: JAMA Internal Medicine, Vol. 177, No. 8, 01.08.2017, p. 1083-1092.

Research output: Contribution to journalArticle

El-Sadr, WM, Donnell, D, Beauchamp, G, Irene Hall, H, Torian, LV, Zingman, BS, Lum, G, Kharfen, M, Elion, R, Leider, J, Gordin, FM, Elharrar, V, Burns, D, Zerbe, A, Gamble, T, Branson, B, King, G, Lucas, J, Ogilive, B, Simmons, R, Toni Young, A, Turner, M, Pollydore, J, Jefferys, R, Johnson, J, Charles, H, Concepcion, R, Richards-Clarke, C, Simpson, Y, Giwa, M, Martin, C, Beatty, A, Dominique, TB, Keyes, DADO, Wallace, S, Farrior, J, Greene, E, Watkins, P, Jennings, A, Stanton, J, Robinson, M, McKinstry, L, Zhuo, J, Ostbye, K, Nathe, C, Buchacz, K, Gray, KM, Li, J, Wu, B, Chen, M, Laffoon, B, Hughes, J, Mermin, J, Coates, T, Keruly, J, Dawson, L, Rausch, D, Piwowar-Manning, E & Chen, Y 2017, 'Financial incentives for linkage to care and viral suppression among HIV-positive patients a randomized clinical trial (HPTN 065)', JAMA Internal Medicine, vol. 177, no. 8, pp. 1083-1092. https://doi.org/10.1001/jamainternmed.2017.2158
El-Sadr, Wafaa M. ; Donnell, Deborah ; Beauchamp, Geetha ; Irene Hall, H. ; Torian, Lucia V. ; Zingman, Barry S. ; Lum, Garret ; Kharfen, Michael ; Elion, Richard ; Leider, Jason ; Gordin, Fred M. ; Elharrar, Vanessa ; Burns, David ; Zerbe, Allison ; Gamble, Theresa ; Branson, Bernard ; King, Georgette ; Lucas, Jonathan ; Ogilive, Brad ; Simmons, Ron ; Toni Young, A. ; Turner, Melissa ; Pollydore, June ; Jefferys, Richard ; Johnson, Jeremiah ; Charles, Hadiyah ; Concepcion, Ruth ; Richards-Clarke, Candia ; Simpson, Yaa ; Giwa, Morénike ; Martin, Charles ; Beatty, Alicia ; Dominique, Tiffany Brown ; Keyes, D'Angelo D.Ontace ; Wallace, Stephaun ; Farrior, Jennifer ; Greene, Elizabeth ; Watkins, Phaedrea ; Jennings, Andrea ; Stanton, Jill ; Robinson, Michelle ; McKinstry, Laura ; Zhuo, Julie ; Ostbye, Kate ; Nathe, Cory ; Buchacz, Kate ; Gray, Kristen Mahle ; Li, Jianmin ; Wu, Baohua ; Chen, Mi ; Laffoon, Benjamin ; Hughes, Jim ; Mermin, Jonathan ; Coates, Tom ; Keruly, Jeanne ; Dawson, Liza ; Rausch, Dianne ; Piwowar-Manning, Estelle ; Chen, Ying. / Financial incentives for linkage to care and viral suppression among HIV-positive patients a randomized clinical trial (HPTN 065). In: JAMA Internal Medicine. 2017 ; Vol. 177, No. 8. pp. 1083-1092.
@article{12fbf555852b4426a5e13883fa675229,
title = "Financial incentives for linkage to care and viral suppression among HIV-positive patients a randomized clinical trial (HPTN 065)",
abstract = "IMPORTANCE Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits. OBJECTIVE To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. DESIGN, SETTING, AND PARTICIPANTS A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, andWashington, DC, to financial incentives or standard of care. INTERVENTIONS Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed. MAIN OUTCOMES AND MEASURES Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System. RESULTS A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95{\%}CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8{\%} higher (95{\%}CI, 0.7{\%}-6.8{\%}; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9{\%}higher (95{\%}CI, 1.4{\%}-8.5{\%}; P = .007) at financial incentive sites. In addition, continuity in care was 8.7{\%}higher (95{\%}CI, 4.2{\%}-13.2{\%}; P < .001) at financial incentive sites. CONCLUSIONS AND RELEVANCE Financial incentives, as used in this study (HPTN 065), significantly increased viral suppression and regular clinic attendance among HIV-positive patients in care. No effect was noted on linkage to care. Financial incentives offer promise for improving adherence to treatment and viral suppression among HIV-positive patients.",
author = "El-Sadr, {Wafaa M.} and Deborah Donnell and Geetha Beauchamp and {Irene Hall}, H. and Torian, {Lucia V.} and Zingman, {Barry S.} and Garret Lum and Michael Kharfen and Richard Elion and Jason Leider and Gordin, {Fred M.} and Vanessa Elharrar and David Burns and Allison Zerbe and Theresa Gamble and Bernard Branson and Georgette King and Jonathan Lucas and Brad Ogilive and Ron Simmons and {Toni Young}, A. and Melissa Turner and June Pollydore and Richard Jefferys and Jeremiah Johnson and Hadiyah Charles and Ruth Concepcion and Candia Richards-Clarke and Yaa Simpson and Mor{\'e}nike Giwa and Charles Martin and Alicia Beatty and Dominique, {Tiffany Brown} and Keyes, {D'Angelo D.Ontace} and Stephaun Wallace and Jennifer Farrior and Elizabeth Greene and Phaedrea Watkins and Andrea Jennings and Jill Stanton and Michelle Robinson and Laura McKinstry and Julie Zhuo and Kate Ostbye and Cory Nathe and Kate Buchacz and Gray, {Kristen Mahle} and Jianmin Li and Baohua Wu and Mi Chen and Benjamin Laffoon and Jim Hughes and Jonathan Mermin and Tom Coates and Jeanne Keruly and Liza Dawson and Dianne Rausch and Estelle Piwowar-Manning and Ying Chen",
year = "2017",
month = "8",
day = "1",
doi = "10.1001/jamainternmed.2017.2158",
language = "English (US)",
volume = "177",
pages = "1083--1092",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "8",

}

TY - JOUR

T1 - Financial incentives for linkage to care and viral suppression among HIV-positive patients a randomized clinical trial (HPTN 065)

AU - El-Sadr, Wafaa M.

AU - Donnell, Deborah

AU - Beauchamp, Geetha

AU - Irene Hall, H.

AU - Torian, Lucia V.

AU - Zingman, Barry S.

AU - Lum, Garret

AU - Kharfen, Michael

AU - Elion, Richard

AU - Leider, Jason

AU - Gordin, Fred M.

AU - Elharrar, Vanessa

AU - Burns, David

AU - Zerbe, Allison

AU - Gamble, Theresa

AU - Branson, Bernard

AU - King, Georgette

AU - Lucas, Jonathan

AU - Ogilive, Brad

AU - Simmons, Ron

AU - Toni Young, A.

AU - Turner, Melissa

AU - Pollydore, June

AU - Jefferys, Richard

AU - Johnson, Jeremiah

AU - Charles, Hadiyah

AU - Concepcion, Ruth

AU - Richards-Clarke, Candia

AU - Simpson, Yaa

AU - Giwa, Morénike

AU - Martin, Charles

AU - Beatty, Alicia

AU - Dominique, Tiffany Brown

AU - Keyes, D'Angelo D.Ontace

AU - Wallace, Stephaun

AU - Farrior, Jennifer

AU - Greene, Elizabeth

AU - Watkins, Phaedrea

AU - Jennings, Andrea

AU - Stanton, Jill

AU - Robinson, Michelle

AU - McKinstry, Laura

AU - Zhuo, Julie

AU - Ostbye, Kate

AU - Nathe, Cory

AU - Buchacz, Kate

AU - Gray, Kristen Mahle

AU - Li, Jianmin

AU - Wu, Baohua

AU - Chen, Mi

AU - Laffoon, Benjamin

AU - Hughes, Jim

AU - Mermin, Jonathan

AU - Coates, Tom

AU - Keruly, Jeanne

AU - Dawson, Liza

AU - Rausch, Dianne

AU - Piwowar-Manning, Estelle

AU - Chen, Ying

PY - 2017/8/1

Y1 - 2017/8/1

N2 - IMPORTANCE Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits. OBJECTIVE To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. DESIGN, SETTING, AND PARTICIPANTS A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, andWashington, DC, to financial incentives or standard of care. INTERVENTIONS Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed. MAIN OUTCOMES AND MEASURES Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System. RESULTS A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95%CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95%CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9%higher (95%CI, 1.4%-8.5%; P = .007) at financial incentive sites. In addition, continuity in care was 8.7%higher (95%CI, 4.2%-13.2%; P < .001) at financial incentive sites. CONCLUSIONS AND RELEVANCE Financial incentives, as used in this study (HPTN 065), significantly increased viral suppression and regular clinic attendance among HIV-positive patients in care. No effect was noted on linkage to care. Financial incentives offer promise for improving adherence to treatment and viral suppression among HIV-positive patients.

AB - IMPORTANCE Achieving linkage to care and viral suppression in human immunodeficiency virus (HIV)-positive patients improves their well-being and prevents new infections. Current gaps in the HIV care continuum substantially limit such benefits. OBJECTIVE To evaluate the effectiveness of financial incentives on linkage to care and viral suppression in HIV-positive patients. DESIGN, SETTING, AND PARTICIPANTS A large community-based clinical trial that randomized 37 HIV test and 39 HIV care sites in the Bronx, New York, andWashington, DC, to financial incentives or standard of care. INTERVENTIONS Participants at financial incentive test sites who had positive test results for HIV received coupons redeemable for $125 cash-equivalent gift cards upon linkage to care. HIV-positive patients receiving antiretroviral therapy at financial incentive care sites received $70 gift cards quarterly, if virally suppressed. MAIN OUTCOMES AND MEASURES Linkage to care: proportion of HIV-positive persons at the test site who linked to care within 3 months, as indicated by CD4+ and/or viral load test results done at a care site. Viral suppression: proportion of established patients at HIV care sites with suppressed viral load (<400 copies/mL), assessed at each calendar quarter. Outcomes assessed through laboratory test results reported to the National HIV Surveillance System. RESULTS A total of 1061 coupons were dispensed for linkage to care at 18 financial incentive test sites and 39 359 gift cards were dispensed to 9641 HIV-positive patients eligible for gift cards at 17 financial incentive care sites. Financial incentives did not increase linkage to care (adjusted odds ratio, 1.10; 95%CI, 0.73-1.67; P = .65). However, financial incentives significantly increased viral suppression. The overall proportion of patients with viral suppression was 3.8% higher (95%CI, 0.7%-6.8%; P = .01) at financial incentive sites compared with standard of care sites. Among patients not previously consistently virally suppressed, the proportion virally suppressed was 4.9%higher (95%CI, 1.4%-8.5%; P = .007) at financial incentive sites. In addition, continuity in care was 8.7%higher (95%CI, 4.2%-13.2%; P < .001) at financial incentive sites. CONCLUSIONS AND RELEVANCE Financial incentives, as used in this study (HPTN 065), significantly increased viral suppression and regular clinic attendance among HIV-positive patients in care. No effect was noted on linkage to care. Financial incentives offer promise for improving adherence to treatment and viral suppression among HIV-positive patients.

UR - http://www.scopus.com/inward/record.url?scp=85027267164&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027267164&partnerID=8YFLogxK

U2 - 10.1001/jamainternmed.2017.2158

DO - 10.1001/jamainternmed.2017.2158

M3 - Article

VL - 177

SP - 1083

EP - 1092

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 8

ER -