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Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial

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Abstract

Achieving viral suppression in people living with HIV improves their quality of life and can help end the HIV/AIDS epidemic. However, few interventions have successfully promoted HIV viral suppression. The purpose of this study was to evaluate the long-term effectiveness of financial incentives for viral suppression in people living with HIV. People living with a detectable HIV viral load (≥ 200 copies/mL) were randomly assigned to Usual Care (n = 50) or Incentive (n = 52) groups. Incentive participants earned up to $10 per day for providing blood samples with an undetectable or reduced viral load. During the 2-year intervention period, the percentage of blood samples with a suppressed viral load was significantly higher among Incentive participants (70%) than Usual Care participants (43%) (OR = 7.1, 95% CI 2.7 to 18.8, p < .001). This effect did not maintain after incentives were discontinued. These findings suggest that frequent delivery of large-magnitude financial incentives for viral suppression can produce large and long-lasting improvements in viral load in people living with HIV. ClinicalTrials.gov Identifier: NCT02363387.

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Data Availability

Deidentified participant data will be available for approved research purposes following completion of secondary analyses. All data requests should be submitted to the corresponding author.

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Acknowledgements

We are grateful to Jacqueline Hampton, who recruited participants for this study and conducted outcome assessments; Calvin Jackson and Sarah Pollock, who collected blood samples for this study; and Haijuan Yan, who conducted statistical analyses.

Funding

The work was supported by the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse of the National Institutes of Health under grants R01AI117065 and T32DA07209. The funders had no role in the study design, data collection, data analysis, data interpretation or writing of the report.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Suite 350 East, Baltimore, MD, 21224, USA

    Matthew D. Novak, August F. Holtyn, Forrest Toegel, Andrew M. Rodewald, Jeannie-Marie Leoutsakos & Kenneth Silverman

  2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Michael Fingerhood

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Contributions

MF and KS conceptualized and designed the study. MF and KS obtained funding. MN, AH, FT, AR, JML, and KS collected and analyzed data. JML conducted statistical analyses. MN and KS drafted the manuscript. All authors provided critical revisions to the manuscript. MN and KS directly accessed and verified the underlying data. All authors had full access to the data in the study and had final responsibility for the decision to submit for publication.

Corresponding author

Correspondence to Kenneth Silverman.

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Ethical Approval and Consent to Participate

The Johns Hopkins Medicine Institutional Review Board approved the study and all procedures were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was monitored by a Scientific Advisory Committee. Staff members reported all events that might be considered adverse events, including deaths, and the investigators determined if any events met the definitions of adverse events as defined by the Johns Hopkins Medicine Institutional Review Board. The investigators, the Scientific Advisory Committee and the Johns Hopkins Medicine Institutional Review Board reviewed all adverse events annually. We registered the trial on Clinicialtrials.gov before recruitment began (NCT02363387). All participants provided written informed consent at enrollment.

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The authors declare no conflicts of interests.

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Novak, M.D., Holtyn, A.F., Toegel, F. et al. Long-Term Effects of Incentives for HIV Viral Suppression: A Randomized Clinical Trial. AIDS Behav 28, 625–635 (2024). https://doi.org/10.1007/s10461-023-04249-z

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