The cash reward system does not work on HIV-positive drug addicts or alcoholics, a new study has found.
The new research, funded by the US National Institute on Drug Abuse, monitored the outcome for people with both substance-abuse problems and HIV – a very difficult group to treat, according to the researchers.
Lisa Metsch, lead researcher from Columbia University, said in a university press release that,
We must get serious about hard-to-reach populations,
in order to lower HIV infection rates, HealthDay News reports.
Giving people cash incentives for improving lifestyles and behavior, such as exercising or quitting smoking, have proven to be somewhat successful in other patient populations. Because of this, Metsch’s team wondered if a similar approach might be viable for HIV-infected people who are also struggling with drug or alcohol abuse.
The researchers tracked the results for over 800 people being cared for at 11 hospitals in major cities across the country. Patients were randomly delegated to any one of three groups: usual treatment where patients were given outpatient HIV care and substance abuse treatment, “patient navigation” where case managers helped patients with their care for six months, or six months of patient navigation plus cash rewards.
The monetary incentives were up to $1,160 if a patient was able to cut back on substance abuse, stick to HIV care and improve clinical results for HIV.
The team’s results were discouraging: rates of suppression of HIV on blood tests showed no difference after one year, no matter which group the patients were assigned to. In each group, only around 33% of patients were able to achieve successful HIV suppression, according to the researchers.
Metsch theory on why the cash incentives or patient navigation were no help is because the participants faced “complex issues including considerable socioeconomic disadvantage.” She believes they need to conduct further research in order to discover other ways to reach this particular target group.
“We will not achieve an AIDS-free generation if we don’t address substance use and the other [illnesses] that come with substance use,” Metsch said.
The study was published in the Journal of the American Medical Association.
