6014.0: Thursday, November 16, 2000 - 9:30 AM

Abstract #10971

Use of cash incentives to improve adherence to antiretroviral (ARV) medication among the HIV+ urban poor

Joshua D. Bamberger, MD, MPH1, George J. Unick, MA2, Wolfgang Stuwe, MA1, and Joan E. Myles, JD, MA1. (1) Urban Community Health, San Francisco Department of Public Health, 101 Grove Street, Room 407, San Francisco, CA 94102, (415) 554-2664, josh_bamberger@dph.sf.ca.us, (2) Action Point, San Francisco AIDS Foundation, 125 6th Street, 94103

Background: A number of tuberculosis adherence studies have shown that offering cash incentives to homeless and marginally housed individuals (the urban poor) improve the likelihood of completion of therapy when compared to non-cash incentives. Offering ARVs to the urban poor is controversial due to fears of low adherence and the concern of development of multiple drug resistant HIV.

Methods: We developed a storefront, community based program to support multiply diagnosed HIV+ individuals to adhere to ARV medications. The program is open 6 days a week and offers medication, case management and acupuncture. Clients can visit as often as daily. An individually tailored web-based paging system is used to notify clients of medication schedule. For clients that come in at least weekly, a ten-dollar cash incentive is offered. Each client who chooses to use the pager system must pay for its rental with one of the cash payments per month.

Results: Over the first 3-month period, 68 clients enrolled. Sixty-seven (98%) had a drug use history, 25 (37%) were homeless and 41 (60%) were taking ARVs. After 5 months, 42 (67%) continue to present once a week for services; 35/42 (83%) are on highly-active antiretroviral therapy and 5/42 (12%) remain homeless.

Conclusion: The use of financial incentives in conjunction with other social and medical support services can retain multiply diagnosed HIV+ individuals in an ARV adherence program. The maximum yearly cost of these incentives is 10% of the retail cost of a year of a single protease inhibitor.

Learning Objectives: 1. Participants will understand the risks and benefits of offering antiretroviral medications to multiply diagnosed individuals. 2. The use of incentives as an adjunct to a comprehensive medication adherence program will be discussed

Keywords: Adherence, HIV/AIDS

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA