Paying substance abusing patients to complete HIV treatment isn't effective in the long run, according to the results of new research partially based in Miami.
Although patients were more likely to take their medicine and visit the doctor at first, the effect of the financial incentives levels off over time and work about as well in the long term as regular treatment or guided treatment.
The study, published in the Journal of the American Medical Association on Tuesday, was a collaboration between more than 17 institutions, including the University of Miami.
The research followed 801 HIV-positive patients with substance abuse problems from July 2012 to January 2014 and tested their viral load three times — at the beginning of the study, six months later and one year later.
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The patients were randomly assigned to receive regular treatment for HIV, guided treatment with a coordinator or guided treatment where patients got paid for achieving milestones.
Visiting an HIV clinic was worth $180. Passing a drug and alcohol test earned patients $220. Overall, they could earn up to $1,160 during the six month “intervention.”
After those six months, the patients who made money were doing better than the other two groups, said Dr. Allan Rodriguez, a top HIV expert at UM and co-author of the study. But a year later, they dropped back to the same rate of success (35 percent) as the other two groups.
“Once you stop paying them it stops working,” he said. “You cannot have interventions for your whole life.”
Rodriguez said although this research didn’t point to a clear answer, the next step is a method that targets substance abuse more aggressively, as well as longer interventions.
Studies like these are important because HIV is still spreading, even though modern medicine can stop the transmission of the virus and save peoples’ lives.
Miami-Dade is the No. 1 city for new HIV infections, he said, and the study cites research showing as many as half of HIV-infected people have or had substance abuse problems.
The study was designed to find solutions for this common but hard-to-reach demographic.
“What is very clear is that the HIV-positive individuals with substance use problems have the most difficulty controlling their HIV infection,” said Daniel Feaster, who collaborated on the study.
Feaster, an associate professor of public health sciences at UM’s Department of Public Health Sciences at the Miller School of Medicine, said the costs of not addressing the problem is high, both in terms of expensive taxpayer-funded hospital stays and potential new HIV infections.
“We know that substance abuse is one of the drivers of the epidemic,” Rodriguez said. “We cannot leave them behind.”