Using financial incentives to support viral load suppression in a community-based organization providing integrated care
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.
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.
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).
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.
Learning Areas:Administer health education strategies, interventions and programs
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Discuss the benefits of a financial incentive as part of a comprehensive community-based program to improve treatment adherence and durable viral load suppression
Keyword(s): HIV/AIDS, Treatment Adherence
Qualified on the content I am responsible for because: I have worked in the field of public health practice and research for 15 years, specifically in HIV for over 6 years. I have an MPH with a focus on sexuality and have completed 2 years of doctoral coursework in community health. I have presented at APHA before and moderated a panel. I have been the primary person analyzing data for this research within our organization and feel highly capable of presenting our findings.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.