CTN 248: Incentives to Stop AIDS and HIV in Drug Users

About The Study

This randomized trial measured the effectiveness of providing incentives as a strategy for increasing the frequency of desired behaviours such as adherence to medications to achieve sustained virologic suppression. This study aimed to find novel and effective means of diagnosing HIV in people with substance use issues and improving antiretroviral uptake and adherence in hard-to-reach populations.

About The Disease

Illicit drug users include a disproportionate number of women, sex trade workers, ethnic minorities, street involved people, and people experiencing homelessness and unstable housing. Research suggests that the rate of HIV prevalence in BC’s Lower Mainland drug using population ranges from 25% to 30%. Illicit drug users often face challenging circumstances that present serious barriers to seeking out and receiving adequate health care. It is critical to focus on HIV care for drug users and other hard-to-reach populations, to both reduce rates of HIV related deaths and to decrease HIV transmission.

Study Approach

This study was conducted in two stages. Participants in the first stage of the study were asked to take an HIV test and related blood tests and complete a questionnaire. Researchers collected clinical, socio-demographic, and behavioural data. Half of the participants in this stage were randomly selected to receive $10 for taking the tests and $15 for returning to get the results to evaluate whether testing behaviour can be altered by providing associated incentives.

The next stage of the study was open to eligible people living with HIV who use. Participants were randomly assigned to one of two groups: standard care and basic compensation for participation or standard card plus additional incentives linked to achieving clinical outcomes. The incentive schedule escalated up to $25 and was linked to clinic visits and treatment results, with the opportunity for additional incentives if HIV viral suppression was reached. Participants were also asked to complete interviews, questionnaires, and urine and blood tests.

Results

The first stage of this study was completed in 2012 with a total of 301 participants enrolled from the Vancouver location. Presented at IAS 2013, the results of this study were extremely significant in that participants randomized to receive cash reinforcers were more likely to complete HIV testing and return for post-test counseling — 126 (83%) of participants who received reinforcers versus 16 (11%) in the non-incentive arm. Additional analyses with data from Prince George, Surrey, and Victoria reinforced this finding. Publication for the second stage of this study is pending.

Data from CTN 248 has also been used for a number of secondary analyses. These include the impact of opioid prescription, the prevalence of age-related diseases, and the effect HCV co-infection and mental health disorders on hospitalization in people living with HIV who use drugs.