Incentives for Viral Suppression in People Living with HIV: A Randomized Clinical Trial

  • Kenneth SilvermanEmail author
  • August F. Holtyn
  • Andrew M. Rodewald
  • Robert F. Siliciano
  • Brantley P. Jarvis
  • Shrinidhi Subramaniam
  • Jeannie-Marie Leoutsakos
  • Carol-Ann Getty
  • Sebastian Ruhs
  • Mark A. Marzinke
  • Michael Fingerhood
Original Paper


The HIV/AIDS epidemic can be eliminated if 73% of people living with HIV take antiretroviral medications and achieve undetectable viral loads. This study assessed the effects of financial incentives in suppressing viral load. People living with HIV with detectable viral loads (N = 102) were randomly assigned to Usual Care or Incentive groups. Incentive participants earned up to $10 per day for 2 years for providing blood samples that showed either reduced or undetectable viral loads. This report presents data on the 1st year after random assignment. Incentive participants provided more (adjusted OR = 15.6, CI 4.2–58.8, p < 0.001) blood samples at 3-month assessments with undetectable viral load (72.1%) than usual care control participants (39.0%). We collected most blood samples. The study showed that incentives can substantially increase undetectable viral loads in people living with HIV. Financial incentives for suppressed viral loads could contribute to the eradication of the HIV/AIDS epidemic.


Incentives Viral suppression Antiretroviral medication adherence HIV ART 


La epidemia de VIH/SIDA podría ser eliminada si el 73% de las personas que viven con VIH tomaran medicamentos antirretrovirales y lograran mantener la carga viral indetectable. Este estudio evaluó el efecto de incentivos económicos sobre la supresión de la carga viral. Personas que viven con VIH cuyas cargas virales estaban detectables (N = 102) fueron asignadas aleatoriamente a recibir atención de rutina o incentivos. Los participantes en el grupo de incentivos podían recibir hasta $10 por día durante dos años si sus muestras de sangre demostaban que la carga viral se había reducido o estaba indetectable. Este informe presenta datos sobre el primer año después de la asignación al azar. Los participantes en el grupo de incentivos proporcionaron más (proporción de probablidades ajustadas = 15.6, CI 4.2-58.8, p < 0.001) muestras cada tres meses con cargas virales indetectables (72.1%) que los participantes que recibieron cuidados de rutina (39.0%). Hemos recolectado la mayoría de las muestras de sangre. El estudio demostró que los incentivos pueden aumentar sustancialmente las cargas virales indetectables en personas que viven con VIH. Los incentivos económicos por mantener la carga viral suprimida podrían contribuir a la erradicación del VIH/SIDA.



We are grateful to Jacqueline Hampton, who recruited participants for this study and conducted outcome assessments; Calvin Jackson, who collected blood samples for this study; and Haijuan Yan, who conducted statistical analyses. The study was supported by the National Institute of Allergy and Infectious Diseases and the National Institute on Drug Abuse of the National Institutes of Health under grants R01AI117065 and T32DA07209. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interests.

Ethical Approval

The Johns Hopkins Medicine Institutional Review Board approved the study. The study was monitored by a Scientific Advisory Committee. Staff members reported all events that might be considered adverse events, including deaths, and the investigators determined if any events met the definitions of adverse events as defined by the Johns Hopkins Medicine Institutional Review Board. The investigators, the Scientific Advisory Committee and the Johns Hopkins Medicine Institutional Review Board reviewed all adverse events annually. We registered the trial on before recruitment began (NCT02363387).


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Kenneth Silverman
    • 1
    Email author
  • August F. Holtyn
    • 1
  • Andrew M. Rodewald
    • 1
  • Robert F. Siliciano
    • 2
  • Brantley P. Jarvis
    • 1
    • 5
  • Shrinidhi Subramaniam
    • 1
    • 6
  • Jeannie-Marie Leoutsakos
    • 1
  • Carol-Ann Getty
    • 1
    • 7
  • Sebastian Ruhs
    • 4
  • Mark A. Marzinke
    • 3
  • Michael Fingerhood
    • 2
  1. 1.Department of Psychiatry and Behavioral Sciences, Center for Learning and HealthJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of MedicineJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of PathologyJohns Hopkins University School of MedicineBaltimoreUSA
  4. 4.Chase Brexton Health CareBaltimoreUSA
  5. 5.Knowesis, LLCFairfaxUSA
  6. 6.Department of Psychology and Child DevelopmentCalifornia State University StanislausTurlockUSA
  7. 7.Addictions Department, Kings CollegeLondonUK

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