“Payment by Results”—Financial Incentives and Motivational Interviewing, Adherence Interventions in Young Adults with Perinatally Acquired HIV-1 Infection: A Pilot Program

Abstract

Emerging evidence suggests financial incentives (FIs) improve medication adherence in select populations. A small proportion of adolescents with perinatal HIV (PaHIV) transfer to adult services with established poor adherence and advanced disease. We describe a single center adherence intervention combining FIs with motivational interviewing (MI). Eligible patients (PaHIV,16-25 years, CD4 count ≤ 200, off ART despite multiple attempts) received MI, and FI dependent on viral load (VL) reduction for 1 year. Outcome measures compared CD4 gain from baseline at 1 year and 12 months post cessation of FI/MI. Eleven young people enrolled; median age 19 years, 8 female. Baseline median CD4 count 30 cells/μL (IQR 10-160), VL 12,870 c/mL. Outcomes at 12 months: 9/11 ever achieved VL < 50, 5 sustained undetectable VL, median CD4 140, mean CD4 gain 90 cells/μL at 1 year. Twelve months post cessation of MI/FI; six VL < 50, median CD4 75, mean CD4 gain 122 cells/μL. Total FI expenditure £1,350: £68 per 50 CD4 cells at 1 year, £55 at 24 months. To prevent death, adolescents with PaHIV require novel interventions to reverse poor patterns of adherence established since childhood. FI/MI improved virological and immunological outcomes with minimal expenditure. Extension of this pilot work for vulnerable individuals is now indicated.

Importance of Self-Motivation and Social Support in Medication Adherence in HIV-Infected Adolescents in the United Kingdom and Ireland: A Multicentre HYPNet Study

“…Early pilot studies have shown encouraging outcomes for motivational interviewing in reducing viral load and unprotected sex and warrant well powered, age stratified randomized controlled trials. [19][20][21] Practical reasons such as holidays or being busy with other activities were frequently identified as a barrier to adherence, and medication-related factors such as once daily regimens and smaller pill sizes were most commonly identified as factors that may improve adherence. Both factors are related to the convenience of taking the medication and suggest efforts to ease medication at a younger age, whilst adherence is still maintained, such as simplification to once daily regimens and FDCs may prove to be beneficial and are welcomed by adolescents.…”

Predictors and Profiles of Antiretroviral Therapy Adherence Among African American Adolescents and Young Adult Males Living with HIV

“…66,68,69 Fortunately, intervention researchers have started to demonstrate the feasibility of incorporating motivational interviewing and cognitivebehavioral interventions into integrated HIV youth treatment settings. 36,[63][64][65][66] However, much work is still needed in the development of such interventions to best serve the psychosocial and medical needs of young African American males living with HIV.…”

“…34 In addition, recent pilot studies with YLH have evaluated novel interventions such as cell phone support 35 as well as utilizing motivational interviewing techniques and financial incentives to increase ART adherence. 36 To date, such studies have shown promise for improving ART adherence among YLH. However, limitations of the aforementioned studies include small sample sizes as well as significant variability among samples (e.g., behavioral vs. perinatal acquisition; disparate sociodemographics and adherence methodology), which notably limits our understanding of predictors and pathways of ART adherence outcomes for young African American males living with HIV.…”

Acceptability and Feasibility of a Cell Phone Support Intervention for Youth Living with HIV with Nonadherence to Antiretroviral Therapy

“…This may suggest that incentives play an important role in helping nonadherent youth stick to their medication. 15 There have been limited data published on the acceptability of adherence interventions with HIV + youth. A small pilot study (N = 18) found 61% preferred motivational interviews to regular office visits.…”