Effects of incentives on viral suppression in people living with HIV who use cocaine or opiates

Background: Antiretroviral therapy (ART) adherence is essential to maintenance of undetectable viral loads among people living with HIV, which improves health and reduces HIV transmission. Despite these benefits, some people living with HIV do not maintain the level of adherence required to sustain an undetectable viral load. This problem is particularly common among people who use drugs. Objective: To determine effects of incentivizing viral suppression in people living with HIV who used cocaine or opiates. Methods: In this secondary analysis of data collected during a randomized controlled trial, participants (N =102) with detectable HIV viral loads (> 200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with reduced or undetectable (< 200 copies/mL) viral loads. All participants completed assessments every three months. Results collected during the first year were compared based on group assignment and drug use. Results: Among participants who used cocaine or opiates, Incentive participants (n = 27) provided more (OR:4.0, CI:1.6 -10.3, p = .004) blood samples with an undetectable viral load (69 %) than Usual Care participants (n = 25; 41 %). Among participants who did not use cocaine or opiates, Incentive participants (n = 25) provided more (OR:4.1, CI:1.5 -10.7, p = .005) blood samples with an undetectable viral load (78 %) than Usual Care participants (n = 25; 36 %). Effects of incentives did not differ by drug use (OR:1.0, CI:0.3 -4.0, p = .992). Conclusions: Incentivizing viral suppression can promote undetectable viral loads in people living with HIV who use cocaine or opiates.