Enhancing patient navigation with contingent incentives to improve healthcare behaviors and viral load suppression of persons with HIV and substance use.
This secondary analysis of data from Clinical Trials Network protocol CTN-0049, Project HOPE, compares outcomes for two groups of HIV+ substance users randomized in a 3-arm trial to receive Patient Navigation with (PN+CM) or without (PN) contingent financial incentives (CM). Mean age of participants was 45 years; the majority was male (67%), African American (78%), unemployed (35%), or disabled (50%). Behaviors incentivized for PN+CM were (1) attendance at HIV care visits and (2) verification of an active HIV medication prescription.
Incentives were associated with shorter time to treatment initiation and higher rates of behaviors during the 6-month intervention with exception of month 6 HIV care visits. Median HIV care visits were 3 (IQR 2–4) for PN+CM versus 1.5 (IQR 0–3) for PN (Wilcoxon p < 0.001); median validated medication checks were 4 (IQR 2–6) for PN+CM versus 1 (IQR 0–3) for PN (Wilcoxon p < 0.001). Viral suppression rates at end of treatment were not significantly different for the two groups but were directly related to the number of behaviors completed for both care visits and validated medication.
Conclusions: Contingent financial incentives added to a PN intervention were associated with better engagement in the navigation intervention, including earlier initiation and higher sustained rates of key health-related behaviors deemed necessary to achieve a final goal of viral load suppression. In addition to higher rates of initiation, it was notable that incentives were associated with a shorter average time both to the initial HIV care visit and to first verified pick up of HIV medication among those who ever initiated these behaviors. These robust results suggest value of incentives as a tool to enhance linkage to care, as well as speeding up or “kick starting” early steps in the care process within a navigation intervention. Adjustments to the incentive program may be needed to achieve greater rates of sustained health behavior change that result in improved viral load outcomes.
Related protocols: CTN-0049, CTN-0049-A-1