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

A randomized clinical trial evaluating the role of contingent reinforcement in the engagement and retention of Drug Users in HAART programs: a substudy of CTN 244

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.

Background

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.

Preliminary 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.

Background

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 BCs 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.

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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.

Investigators

Here’s who is leading this study.

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Participating Sites

VIDUS/ACCESS Project

  • Dr. Mark Hull
  • 342 East Hasting St. Vancouver, BC V6A 1P4
  • Contact Person
  • vidus@cfenet.ubc.ca
  • 604-685-6355

John Ruedy Immunodeficiency Clinic

  • Site Investigator
  • St. Paul’s Hospital Vancouver, BC V6Z 1Y6
  • Contact Person
  • contact@email.com
  • 605-806-8060

Positive HAVEN South Fraser

  • Site Investigator
  • 10697 135a St. Surrey, BC V3T 4E3
  • Contact Person
  • contact@email.com
  • 604-588-9004

Jim Pattison Outpatient Care and Surgery Centre

  • Site Investigator
  • 9750 140 St. Surrey, BC V3T 0G9
  • Contact Person
  • contact@email.com
  • 604-582-4550

University Hospital of Northern BC

  • Site Investigator
  • 1475 Edmonton St. Prince George, BC V2M 1S2
  • Contact Person
  • contact@email.com
  • 250-565-2000

Interior Health Region

  • Site Investigator
  • Kelowna, Kamloops, Vernon, Salmon Arm
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999

Oak Tree Clinic

  • Site Investigator
  • 4500 Oak St. Vancouver, BC V6H 2N9
  • Contact Person
  • contact@email.com
  • 604-875-2212

Victoria Cool Aid Society

  • Site Investigator
  • 3806 Carey Rd. Victoria, BC V8Z 3T2
  • Contact Person
  • contact@email.com
  • 250-383-3301
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999
  • Site Investigator
  • 12345 Street Name,
    City Name, BC V3M 9J3
  • Contact Person
  • contact@email.com
  • 1 (604) 555-9999

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