Using financial incentives to support viral load suppression in a community-based organization providing integrated care

background:

The Viral Load Suppression (VLS) Project is a 24-month demonstration project with projected enrollment of 700 formerly homeless people living with HIV/AIDS. The primary objective is supporting ARV adherence to achieve viral suppression (≤50 copies/ml). The program uses a tiered set of evidence-based adherence interventions including a quarterly $100 financial incentive for achieving or maintaining viral suppression.

methods:

Using durable viral load as the primary outcome variable, with each participant as their own control, viral load is measured at three month intervals starting 6 months prior to enrollment (to establish a baseline) and continuing up to 6 months after the 24-month intervention ends.

results:

By November 2015, 18-month results will be presented. Among clients eligible for enrollment in the VLS Project at inception, 54% were virally suppressed and approximately 40% had experienced viral rebound at some point during a 24-month look-back.

Current data show 82.5% of clients (n=183) active in the project for nine months were virally suppressed at their latest lab report. On average, 55% of these clients were virally suppressed at all time points post-VLS intervention, compared to just 27% of participants prior to the VLS intervention (p<.0001). On average, participants were virally suppressed at 67% of all measured time points after entering the VLS program, compared to 57% of measured time points before entering the VLS program (p<.0005).

conclusions:

Financial incentives may be a feasible, sustainable and scalable component of a cost-effective program of ARV adherence supports for PLWHA who face multiple social/structural barriers to medication compliance.