TUAC0203 - Oral Abstract Session
Use of modest financial incentives to improve engagement of drug users in HIV testing and follow-up: results of a randomized controlled trial
Presented by Mark Hull (Canada).
M. Hull1, C. Otieno1, J. Singer2, E. Ding1, J. Zhu1, T. Kerr1, E. Wood1, M. Harris1, K. Shannon1, R. Barrios1, R. Hogg1, N. Petry3, J. Montaner1
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2UBC School of Population and Public Health, Vancouver, Canada, 3University of Connecticut Health Center, Farmington, United States
Background: Interventions to improve HIV testing rates amongst at-risk populations are required as a component of 'Treatment as Prevention' strategies. This study evaluated the efficacy of offering modest financial incentives linked to HIV testing and post-test counseling in a substance-using population.
Methods: After initial screening for eligibility, 301 illicit drug and/or alcohol users from Vancouver's Downtown Eastside neighbourhood were randomized 1:1 to receive either standard of care counseling and HIV testing alone (non-incentive arm; N=150), or standard of care counseling and HIV testing plus cash incentives (incentive arm; N=151). Participants in the incentive arm received $10 upon completing laboratory testing at visit 1, and an additional $15 after returning to review test results at visit 2 within 4 weeks. Statistical analysis was performed using chi-square test or Fisher's exact test for categorical variables and Wilcoxon rank-sum test for continuous variables. A multivariate logistic regression model considering possible confounders including age, gender, ethnicity and frequency of drug use was used to estimate the probability of completing testing and returning for test results, with the variable of interest being receipt of incentives.
Results: Of 301 participants, 67% were male and the median age (IQR) was 45 years (36-51). The participants had an ethnic distribution of approximately 56% Caucasian, 40% Aboriginal, 2.3% Black and 0.3% Asian. All 151 participants (100%) randomized to receive incentives completed testing, as compared to 48/150 (32%) in the non-incentive arm (p< 0.001). Additionally, 126 (83%) of participants randomized to receive incentives returned for their test results, compared to 16 (11%) in the non-incentive arm (p< 0.001). In multivariate analysis, receipt of incentives was strongly associated with completion of post-test visits after adjusting for confounders (adjusted odds ratio 18.54; 95% confidence interval, 8.73 - 39.38).
Conclusion: The use of modest cash incentives dramatically increased rates of engagement in HIV testing and follow-up among drug users. Our results demonstrate that modest cash incentives represent a powerful strategy for engaging drug users in HIV testing and post-test counseling interventions as a component of 'Treatment as Prevention´ programs.
Acknowledgement: This study was funded by the National Institute on Drug Abuse.
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