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      Enhancing Patient Navigation with Contingent Incentives to Improve Healthcare Behaviors and Viral Load Suppression of Persons with HIV and Substance Use

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          Abstract

          This secondary analysis compares health behavior outcomes for two groups of HIV+ substance users randomized in a 3-arm trial [1] to receive Patient Navigation with (PN+CM) or without (PN) contingent financial incentives (CM). Mean age of participants was 45 years; the majority was male (67%), African American (78%), unemployed (35%), or disabled (50%). Behaviors incentivized for PN+CM were (1) attendance at HIV care visits and (2) verification of an active HIV medication prescription. Incentives were associated with shorter time to treatment initiation and higher rates of behaviors during the 6-month intervention with exception of month 6 HIV care visits. Median HIV care visits were 3 (IQR 2–4) for PN+CM versus 1.5 (IQR 0–3) for PN (Wilcoxon p < 0.001); median validated medication checks were 4 (IQR 2–6) for PN+CM versus 1 (IQR 0–3) for PN (Wilcoxon p < 0.001). Viral suppression rates at end of treatment were not significantly different for the two groups but were directly related to the number of behaviors completed for both care visits (χ 2(1) = 7.69, p = 0.006) and validated medication (χ 2(1) = 8.49, p = 0.004). Results support use of incentives to increase performance of key healthcare behaviors. Adjustments to the incentive program may be needed to achieve greater rates of sustained health behavior change that result in improved viral load outcomes.

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          Author and article information

          Journal
          AIDS Patient Care STDS
          AIDS Patient Care STDS
          apc
          AIDS Patient Care and STDs
          Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
          1087-2914
          1557-7449
          01 July 2018
          01 July 2018
          : 32
          : 7
          : 288-296
          Affiliations
          [ 1 ]Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine , Hopkins Bayview Medical Center, Baltimore, Maryland.
          [ 2 ] San Francisco Department of Public Health , San Francisco, California.
          [ 3 ]UCSF Department of Psychiatry, Zuckerberg San Francisco General Hospital and Trauma Center , San Francisco, California.
          [ 4 ]Department of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida.
          [ 5 ]Department of Sociomedical Sciences Mailman School of Public Health, Columbia University , New York, New York.
          [ 6 ]Hubert Department of Global Health, Rollins School of Public Health of Emory University , Atlanta, Georgia.
          Author notes
          Address correspondence to: Maxine Stitzer, PhD, Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Baltimore, MD 21224, E-mail: mstitzer@ 123456jhmi.edu
          Article
          PMC6034401 PMC6034401 6034401 10.1089/apc.2018.0014
          10.1089/apc.2018.0014
          6034401
          29883190
          3ccd682f-d56f-4f25-8d19-fbf093e4ec00
          Copyright 2018, Mary Ann Liebert, Inc.
          History
          Page count
          Figures: 4, Tables: 3, References: 31, Pages: 9
          Categories
          Behavioral and Psychosocial Research

          patient navigation,viral suppression,medication adherence,contingency management,HIV healthcare,substance users

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