In North America, approximately 25% of human immunodeficiency virus (HIV) cases are attributable to injection drug use. Illicit drug users (DU) as a whole represent some of North America's most vulnerable populations and include a disproportionate number of women, sex trade workers, ethnic minorities, street involved persons and the homeless. DU with HIV who start and remain on successful treatment are less likely to become ill or die, and also are less likely to pass the infection on to their sexual and drug using partners. Unfortunately, DU are less likely than non-DU to start HIV treatment, and if they do start, they are less likely to stay on it. One possible strategy to address this problem is to provide DU with money as an incentive for starting HIV treatment and for taking it regularly over a period of time to ensure treatment success. Such incentives have been used successfully to reinforce desired behaviors in other fields such as weight management. The proposed research seeks to assess the effectiveness of monetary reinforcers in engaging and retaining HIV-infected DU in HIV treatment programs. First, 300 DU found through outreach will be randomly assigned to receive (150) or not (150) a gift card for participating in the screening process that determines whether they are eligible for HIV treatment, including a clinic visit with laboratory testing ($10) and a return clinic visit to receive the results ($40).
The aim of this part is to see whether the DU offered the reinforcer will be more likely to complete the screening process. Next, 240 DU who are eligible to start HIV treatment will be assigned to either receive (160) or not (80) a small monetary reinforcer for the first year while taking treatment. For the first 6 months, study participants assigned to the intervention arm will receive a small monetary reinforcer (starting at $10 and increasing to $25) at the end of each monthly clinic visit that they attend. For the next 6 months, when they attend clinic visits AND their blood tests determine that the treatment is being taken regularly and is successful, they will receive a reinforcer (which will be variable based on a """"""""fishbowl prize draw"""""""" system). Finally, they will be seen after another 6 months on treatment, to see if receiving reinforcers during the first year makes them more likely to still be taking successful HIV treatment 6 months later. All study participants will receive standard medical treatment for HIV.

Public Health Relevance

It is critical that drug users become a focus of HIV care in order to reduce the rates of HIV- related illness and death in this group, and also to decrease the risk of HIV transmission to their sexual and drug using partners. Financial reinforcers may increase recruitment of this population into HIV treatment and lead to higher rates of long-term retention and treatment success at a reasonable cost. The scientific evaluation of this intervention strategy will be of value to health policy-makers throughout the world.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
4R01DA031043-03
Application #
8445143
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Aklin, Will
Project Start
2011-04-15
Project End
2016-03-31
Budget Start
2013-04-01
Budget End
2014-03-31
Support Year
3
Fiscal Year
2013
Total Cost
$620,080
Indirect Cost
$44,022
Name
University of British Columbia
Department
Type
DUNS #
251949962
City
Vancouver
State
BC
Country
Canada
Zip Code
V6 1-Z3
Eyawo, Oghenowede; Hull, Mark W; Salters, Kate et al. (2018) Cohort profile: the Comparative Outcomes And Service Utilization Trends (COAST) Study among people living with and without HIV in British Columbia, Canada. BMJ Open 8:e019115
Ma, Huiting; Villalobos, Conrado Franco; St-Jean, Martin et al. (2018) The impact of HCV co-infection status on healthcare-related utilization among people living with HIV in British Columbia, Canada: a retrospective cohort study. BMC Health Serv Res 18:319
Eyawo, Oghenowede; Franco-Villalobos, Conrado; Hull, Mark W et al. (2017) Changes in mortality rates and causes of death in a population-based cohort of persons living with and without HIV from 1996 to 2012. BMC Infect Dis 17:174
Harris, Marianne; Ganase, Bruce; Watson, Birgit et al. (2017) HIV treatment simplification to elvitegravir/cobicistat/emtricitabine/tenofovir disproxil fumarate (E/C/F/TDF) plus darunavir: a pharmacokinetic study. AIDS Res Ther 14:59
Wainberg, Mark A; Hull, Mark W; Girard, Pierre-Marie et al. (2016) Achieving the 90-90-90 target: incentives for HIV testing. Lancet Infect Dis 16:1215-1216
Hull, Mark; Lange, Joep; Montaner, Julio S G (2014) Treatment as prevention--where next? Curr HIV/AIDS Rep 11:496-504
Lourenço, Lillian; Lima, Viviane D; Heath, Kate et al. (2014) Process monitoring of an HIV treatment as prevention program in British Columbia, Canada. J Acquir Immune Defic Syndr 67:e94-e109
Cescon, Angela; Kanters, Steve; Brumme, Chanson J et al. (2014) Trends in plasma HIV-RNA suppression and antiretroviral resistance in British Columbia, 1997-2010. J Acquir Immune Defic Syndr 65:107-14
Hull, Mark W; Montaner, Julio S G (2013) HIV treatment as prevention: the key to an AIDS-free generation. J Food Drug Anal 21:S95-S101
Hull, Mark W; Wu, Zunyou; Montaner, Julio S G (2012) Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention. Curr Opin HIV AIDS 7:579-86

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