P06.03
Background: HPTN 065 (TLC-Plus) studied the effect of providing quarterly $70 financial incentives (FI) to HIV-infected patients on anti-retroviral therapy (ART) with HIV RNA<400 copies/mL to encourage ART adherence. Nineteen HIV care sites randomized to the FI intervention dispensed a total of 39,359 FI gift cards over two years in the Bronx, NY and Washington, DC.
Methods: Semi-structured interviews were conducted with 75 patients from 14 sites and 12 site investigators (SIs) (mostly providers); three focus groups were conducted with 12 staff members from 10 sites. Data were analyzed qualitatively to determine the impact of the FI program on clinic environment.
Results: The majority of patients interviewed noticed no effect on their clinic experience due to the FI program. SIs and staff reported that the study-imposed timing of quarterly viral load tests necessary to qualify for FIs often conflicted with typical clinical care schedules and caused clinics to become busier as patients visited frequently or adhered to appointments. SIs saw a benefit to this (better engagement in care), but it also increased demands on staff time and space and interfered with clinic flow. Some SIs and staff found determining eligibility, tracking and disbursing gift cards to be logistically challenging. Some staff also had difficulty dealing with patients who felt “entitled” to FIs and discussing eligibility for FIs in semi-private spaces. SIs and staff described a learning curve as processes were developed to improve logistics, clinic flow, and FI and patient tracking, and as patients and providers became educated about program requirements. Most SIs attributed smooth implementation to well-trained and dedicated staff and provider buy-in. Many indicated that positive patient interactions with the FIs outweighed implementation challenges.
Conclusions: A large scale FI program posed challenges for providers and staff that were mitigated by effective systems and education without negative effects on patients' clinic experiences.
