Do financial incentives (FI) and motivational interviewing (MI) promote adherence in vertically infected HIV positive adolescents?

Introduction: Funding was received for 10 patients to participate in a FI & MI scheme aiming to achieve viral load (VL) reduction. 

Methods: Eligibility criteria: 16-25 years, vertically acquired HIV-1 infection, CD4 <350 cells/ul, agrees to ART with treatable virus, poor adherence since diagnosis & failure to achieve VL <40 copies/ml. FIs received for VL reductions ≥ 1 log weeks 2 & 4 and VL <40 week 8, 3/12, 6/12, 9/12 and 1 year. £20 given for VL reduction ≥ 1 log and £50 for VL <40. Adherence support with motivational interviewing (MI) was provided at each visit.

Results: 8 patients enrolled 1/8/12-1/12/15. 5 females, median age 24 years (range 20-26). Mean baseline VL 35750, this reduced to 1390 (mean VL reduction 21842 copies/ml). 5/8 patients achieved VL <40. N=1 had never achieved VL <40, yet during the scheme achieved VL <40 for 8/12. 3 patients were unable to achieve VL <40. Their lowest VL was 71, 883 and 90, representing a 1-2 log VL drop from baseline after 52/12, 4/12 and 1/12, respectively. 1 patient passed away following a Steven-Johnson reaction, never achieving VL <40. Financial incentives given totalled £640.

Discussion: Despite widely available treatment options for HIV, preventable deaths still occur each year due to a lack of adherence. Within this cohort, 5 patients were able to achieve periods of VL <40 after years of detectability. These results highlight that FI in conjunction with MI, may have a role in improving adherence for the adolescent HIV infected population.

Do financial incentives (FI) and motivational interviewing (MI) promote adherence in vertically infected HIV-1 positive adolescents?

The Joint Annual Conference of the British Association for Sexual Health and HIV & the Society for the Study of Sexually Transmitted Diseases in Ireland