P23.14
Background: HPTN 065 (TLC-Plus) studied the effect of providing quarterly $70 financial incentives (FI) to HIV-infected patients on antiretroviral therapy (ART) to encourage ART adherence. Viral suppression (VS), defined as HIV RNA<400 copies/mL, was used a marker of ART adherence. Nineteen participating sites in the Bronx, NY and Washington, DC, randomized to the FI intervention, dispensed 39,359 FI gift cards over 2 years.
Methods: Semi-structured interviews were conducted with 75 patients ages 14–72 from 14 sites and 17 site investigators (SI) (mostly clinicians); three focus group discussions were conducted with a total of 12 site staff from 10 sites. Data were analyzed to assess opinions about the program and use of FI for VS.
Results: Nearly all patients had a positive opinion of the program: they enjoyed receiving the FI, liked that it offered an incentive for improved health, and thought FI could help some people improve ART adherence. At the same time, many patients felt they and others should be self-motivated to remain adherent and should not have to be incentivized. A few patients felt FI were unnecessary for themselves as they had already achieved VS. SIs were more likely than staff to report positive patient interactions, increased patient adherence to clinic visits and engagement in care. The majority of SIs liked the ability to reward patients, although some felt FI should have been targeted only to low adherers. Several SIs indicated that they had been opposed to FI for VS at the start of the study but were in favor by the end, primarily due to positive patient interactions as SIs were uncertain about the effect on VS. Staff reported implementation challenges and although some reported positive patient interactions, others disliked when patients felt “entitled” to the FI.
Conclusions: Although staff reported some challenges, the FI program was generally well received by patients, SIs and staff, despite the fact that some disagreed with the concept of FI for VS.
