Voucher Incentives Improve Linkage to and Retention in Care Among HIV-Infected Drug Users in Chennai, India

Solomon, Sunil Suhas; Srikrishnan, Aylur K.; Vasudevan, Canjeevaram K.; Anand, Santhanam; Kumar, Muniratnam Suresh; Balakrishnan, Pachamuthu; Mehta, Shruti H.; Solomon, Suniti; Lucas, Gregory M.
August 2014
Clinical Infectious Diseases;Aug2014, Vol. 59 Issue 4, p589
Academic Journal
Modest voucher incentives were associated with significantly better linkage to and retention in care but not with virologic suppression among human immunodeficiency virus (HIV)-infected drug users in Chennai, India, a population with high HIV disease burden and low access to antiretroviral therapy.Background. Drug users (DUs), a population that accounts for some of the fastest-growing human immunodeficiency virus (HIV) epidemics globally, lag behind other populations with regard to HIV-related outcomes. We evaluated the role of voucher incentives on linkage and retention in care among DUs in India.Methods. In this randomized clinical trial, 120 DUs who were aged ≥18 years, HIV-infected, antiretroviral therapy (ART) naive, and ART eligible and who reported drug use in the prior month were randomized to incentive (INC) or control (CTL) conditions for 12 months. Participants randomized to the INC arm received incentives (redeemable for food/household goods) ranging in value from USD4 to USD8 for achieving prespecified targets (eg, ART initiation, visits to ART center). Subjects in the CTL group could win vouchers in prize-bowl drawings, but HIV care behaviors were not incentivized. The primary endpoint was time to ART initiation.Results. Sixty participants each were randomized to the INC and CTL arms between December 2009 and September 2010. Participants in the INC arm were more likely to visit the government ART center (49 vs 33; P = .002); 27 participants in the INC and 16 participants in the CTL arm initiated ART (P = .04; hazard ratio for ART = 2.33 [95% confidence interval, 1.15–4.73]). Participants in the INC arm also had significantly more visits to the ART center (median number of visits, 8 vs 3.5; P = .005). However, no difference in viral suppression was observed.Conclusions. Modest voucher incentives improved linkage to and retention in HIV care, but did not significantly impact viral suppression among DUs in India, a disenfranchised and difficult-to-treat population.Clinical Trials Registration. NCT01031745.


Related Articles

  • Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy. Grund, Birgit; Baker, Jason V; Deeks, Steven G.; Wolfson, Julian; Wentworth, Deborah; Cozzi-Lepri, Alessandro; Cohen, Calvin J.; Phillips, Andrew; Lundgren, Jens D.; Neaton, James D.; null, null // PLoS ONE;5/12/2016, Vol. 11 Issue 5, p1 

    Background: Despite effective antiretroviral treatment (ART), HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers), perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk...

  • A Cluster Randomized Trial of Routine HIV-1 Viral Load Monitoring in Zambia: Study Design, Implementation, and Baseline Cohort Characteristics. Koethe, John R.; Westfall, Andrew O.; Luhanga, Dora K.; Clark, Gina M.; Goldman, Jason D.; Mulenga, Priscilla L.; Cantrell, Ronald A.; Chi, Benjamin H.; Zulu, Isaac; Saag, Michael S.; Stringer, Jeffrey S. A. // PLoS Clinical Trials;Mar2010, Vol. 7 Issue 3, Special section p1 

    Background:The benefit of routine HIV-1 viral load (VL) monitoring of patients on antiretroviral therapy (ART) in resource-constrained settings is uncertain because of the high costs associated with the test and the limited treatment options. We designed a cluster randomized controlled trial to...

  • Population-Based Monitoring of Emerging HIV-1 Drug Resistance on Antiretroviral Therapy and Associated Factors in a Sentinel Site in Cameroon: Low Levels of Resistance but Poor Programmatic Performance. Billong, Serge C.; Fokam, Joseph; Aghokeng, Avelin F.; Milenge, Pascal; Kembou, Etienne; Abessouguie, Ibile; Meva’a-Onglene, Flore Beatrice; Bissek, Anne C. Zoung-Kanyi.; Colizzi, Vittorio; Mpoudi, Eitel N.; Elat, Jean-Bosco N.; Shiro, Koulla S. // PLoS ONE;Aug2013, Vol. 8 Issue 8, p1 

    Background: Scale-up of antiretroviral therapy (ART) in resource-limited settings has drastically reduced HIV-related morbidity and mortality. However, challenges in long-term ART, adherence and HIV drug resistance (HIVDR) itself, require monitoring to limit HIVDR emergence among ART-experienced...

  • A randomized trial of two-drug versus three-drug tenofovir-containing maintenance regimens in virologically controlled HIV-1 patients. Girard, Pierre-Marie; Cabié, André; Michelet, Christian; Verdon, Renaud; Katlama, Christine; Mercié, Patrick; Morand-Joubert, Laurence; Pétour, Pascal; Monchecourt, Françoise; Chêne, Geneviève; Trylesinski, Aldo // Journal of Antimicrobial Chemotherapy (JAC);Jul2009, Vol. 64 Issue 1, p126 

    Objectives To assess simplified maintenance regimens containing dual antiretroviral drugs in patients with controlled human immunodeficiency virus type 1 infection. Methods A non-inferiority, randomized, multicentre, open-label trial was performed in 24 AIDS clinical centres in France...

  • A Randomized Trial of Directly Administered Antiretroviral Therapy and Adherence Case Management Intervention. Wohl, Amy Rock; Garland, Wendy H.; Valencia, Rosa; Squires, Kathleen; Witt, Mallory D.; Kovacs, Andrea; Larsen, Robert; Hader, Shannon; Anthony, Monique-Nicole; Weidle, Paul J. // Clinical Infectious Diseases;6/1/2006, Vol. 42 Issue 11, p1619 

    Background. A randomized, controlled trial was conducted to evaluate the impact of a directly administered antiretroviral therapy program (DAART) and intensive adherence case management (IACM) intervention on virologic and immunologic response to highly active antiretroviral therapy (HAART)...

  • Relationship between CD4+ Count and Non-AIDS Diseases in HIV Patients. Winslow, Dean L. // Infectious Disease Alert;Jun2008, Vol. 27 Issue 9, p101 

    EXACTLY 1397 ANTIRETROVIRAL (ARV) NAÏVE PATIENTS initiating ARVs, as part of a CPCRA-sponsored clinical trial (FIRST trial), were followed for a median of five years. Patients were randomized to one of three arms (NRTIs + PI, NRTIs + nnRTI, NRTIs + PI + nnRTI). CD4+ lymphocyte count, HIV RNA,...

  • Preventive misconception and adolescents' knowledge about HIV vaccine trials. Ott, Mary A; Alexander, Andreia B; Lally, Michelle; Steever, John B; Zimet, Gregory D // Journal of Medical Ethics;Dec2013, Vol. 39 Issue 12, p765 

    Objective Adolescents have had very limited access to research on biomedical prevention interventions despite high rates of HIV acquisition. One concern is that adolescents are a vulnerable population, and trials carry a possibility of harm, requiring investigators to take additional...

  • Viral Load Decay in Antiretroviral-Naïve Patients Receiving Once-Daily Tenofovir and Emtricitabine plus Twice-Daily Nevirapine. Anthony Amoroso; Bruce Gilliam; Rohit Talwani; Colleen Boyce; Robert Redfield; Charles Davis // HIV Clinical Trials;Sep2009, Vol. 10 Issue 5, p320 

    Purpose: The once-daily nucleoside reverse transcriptase inhibitor backbone of tenofovir and emtricitabine has been proven effective in combination with efavirenz and protease inhibitors in large clinical trials. This study evaluated tenofovir and emtricitabine in combination with nevirapine....

  • Clinical and virological response to antiretroviral drugs among HIV patients on first-line treatment in Dar-es-Salaam, Tanzania. Mosha, Fausta; Ledwaba, Johanna; Ndugulile, Faustine; Ng'ang'a, Zipora; Nsubuga, Peter; Morris, Lynn; Kasubi, Mabula; Swai, Andrew; Vercauteren, Jurgen; Vandamme, Anne-Mieke // Journal of Infection in Developing Countries;Jul2014, Vol. 8 Issue 7, p845 

    Introduction: In Tanzania, the follow-up on antiretroviral therapy (ART) response is based on clinical outcomes. We investigated virological response and ARV resistance mutations in relation to clinical response in ARV-treated patients. Methodology: A cross-sectional study of a cohort of 150...

  • Seroconversion Following Nonoccupational Postexposure Prophylaxis against HIV. Roland, Michelle E.; Neilands, Torsten B.; Krone, Melissa R.; Katz, Mitchell H.; Franses, Karena; Grant, Robert M.; Busch, Michael P.; Hecht, Frederick M.; Shacklett, Barbara L.; Kahn, James O.; Bamberger, Joshua D.; Coates, Thomas J.; Chesney, Margaret A.; Martin, Jeffrey N. // Clinical Infectious Diseases;11/15/2005, Vol. 41 Issue 10, p1507 

    Background. The efficacy of antiretroviral postexposure prophylaxis (PEP) against infection with human immunodeficiency virus (HIV) following occupational exposures has prompted the use of PEP after nonoccupational exposures. There are, however, important differences between occupational and...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics