Examining the Implementation of Conditional Financial Incentives Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework to Improve HIV Outcomes among Persons Living with HIV (PLWH) in Louisiana

Sarah Chrestman, Tejal Patel, Katherine Lass, Catherine Maulsby, Hayley Alexander, Charlie Schwanz, Kimberley O’Brien, Waref Azmeh, Austin Matthews, Latoya Decuir, Dionne Bell, Julie Cacioppo, Tina Martinez, Julie D. Doyle, Angie J. Brown, Shamekia Wave, Rubina Abrol, Tammeka Evans and Russell Brewer
Additional contact information
Sarah Chrestman: Louisiana Public Health Institute, New Orleans, LA 70130, USA
Tejal Patel: School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
Katherine Lass: The Policy & Research Group (PRG), New Orleans, LA 70118, USA
Catherine Maulsby: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
Hayley Alexander: Louisiana Department of Health, Bureau of Planning and Performance, Baton Rouge, LA 70821, USA
Charlie Schwanz: Louisiana Public Health Institute, New Orleans, LA 70130, USA
Kimberley O’Brien: AHF Baton Rouge Healthcare Centers, Baton Rouge, LA 70809, USA
Waref Azmeh: AHF Baton Rouge Healthcare Centers, Baton Rouge, LA 70809, USA
Austin Matthews: Social Research and Evaluation Center, Louisiana State University, Baton Rouge, LA 70803, USA
Latoya Decuir: CareSouth Medical and Dental, Baton Rouge, LA 70806, USA
Dionne Bell: CareSouth Medical and Dental, Baton Rouge, LA 70806, USA
Julie Cacioppo: Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
Tina Martinez: Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
Julie D. Doyle: Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
Angie J. Brown: Our Lady of the Lake Regional Medical Center, Baton Rouge, LA 70808, USA
Shamekia Wave: Multispecialty Care Clinic, Baton Rouge, LA 70806, USA
Rubina Abrol: The Medical Affairs Company, Kennesaw, GA 30144, USA
Tammeka Evans: ViiV Healthcare, Research Triangle Park, Durham, NC 27709, USA
Russell Brewer: Department of Medicine, University of Chicago, Chicago, IL 60637, USA

IJERPH, 2022, vol. 19, issue 15, 1-17

Abstract: Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). The Baton Rouge Positive Pathway Study (BRPPS), a mixed method implementation science study, was conducted to assess key RE-AIM components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Seven hundred and eighty-one (781) PLWH enrolled at four HIV clinic sites were included in the final analyses. Participants completed an initial baseline survey, viral load test, and were contacted at 6 and 12 months (±1 month) post-enrollment for follow-up labs to monitor viral load levels. Participants received up to USD140 in conditional financial incentives. The primary analyses assessed whether participation in the BRPPS was associated with an increase in the proportion of participants who were: (a) engaged in care, (b) retained in care and (c) virally suppressed at baseline to 6 and 12 months post-baseline. We constructed a longitudinal regression model where participant-level outcomes at times t 0 (baseline) and t 1 (6- or 12-month follow-up) were modeled as a function of time. A secondary analysis was conducted using single-level regression to examine which baseline characteristics were associated with the outcomes of interest at 12-month follow-up. Cost analyses were also conducted with three of the participating clinics. Most participants identified as Black/African American (89%). Fewer than half of participants reported that they were unemployed or made less than USD5000 annually (43%). Over time, the proportion of participants engaged in care and retained in care significantly increased (70% to 93% and 32% to 64%, p < 0.00). However, the proportion of virally suppressed participants decreased over time (59% to 34%, p < 0.00). Implementation costs across the three sites ranged from USD17,198.05 to USD396,910.00 and were associated with between 0.37 and 1.34 HIV transmissions averted at each site. Study findings provide promising evidence to suggest that conditional financial incentives could help support engagement and retention in HIV care for a high need and at risk for falling out of HIV care population.

Keywords: financial incentives; HIV care continuum; South; people living with HIV; implementation science; RE-AIM (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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