Cash Rewards For HIV-Positive Drug Addicts Won't Improve Health Outcomes

Giving cash incentives to HIV-positive patients battling with substance abuse to improve their unhealthy behavior does not work in the long term, findings of a new study have revealed.

Researchers have found that while the cash rewards can initially get patients to engage in healthy behaviors such as taking their medicines and visiting the doctor, the outcome was comparable to those of other interventions in the long run.

For the study, which was published in the Journal of the American Medical Association on July 12, investigators tracked 801 HIV-positive patients with substance abuse problems.

The patients were randomly assigned to get usual treatment, guided treatment with a coordinator or guided treatment with cash rewards when patients achieve milestones.

For those in the group receiving financial incentives, visiting an HIV clinic can get them a cash reward worth $180 while passing an alcohol or drug test can earn them $220.

Over a period of six months, patients in this group can earn up to $1,160 for targeted behaviors that aimed to reduce substance use, improve HIV outcomes and increase HIV care engagement.

The researchers found that after six months, the patients who received financial incentives were doing better compared with those in the other two groups.

The gap, however, did not last long as researchers found that after only a year, the patients who made money from engaging in healthy behaviors dropped back to the same success rate as those in the groups that did not receive cash rewards.

Study researcher Allan Rodriguez, from the University of Miami, and colleagues reported that the rate of suppression of HIV on blood tests turned out the same for all groups after one year with only about one-third of the patients in each group successfully achieving viral suppression.

"Once you stop paying them it stops working," Rodriguez said. "You cannot have interventions for your whole life."

Giving financial incentives has been somewhat successful in improving health outcomes in some patient populations but this does not seem to be the case when it comes to HIV-infected people who are battling alcohol or drug abuse.

Rodriguez said that aside from longer interventions, the next step should be a system that can target substance abuse in a more aggressive manner. 

"Among hospitalized patients with HIV infection and substance use, patient navigation with or without financial incentives did not have a beneficial effect on HIV viral suppression relative to nonsuppression or death at 12 months vs. treatment as usual," the researchers wrote in their study. "These findings do not support these interventions in this setting."

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