Effectiveness of Financial Incentives in Achieving UNAID Fast-Track 90-90-90 and 95-95-95 Target of HIV Care Continuum:
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ORIGINAL PAPER
Effectiveness of Financial Incentives in Achieving UNAID Fast‑Track 90‑90‑90 and 95‑95‑95 Target of HIV Care Continuum: A Systematic Review and Meta‑Analysis of Randomized Controlled Trials Yuvaraj Krishnamoorthy1 · Tanveer Rehman1 · Manikandanesan Sakthivel2 Accepted: 11 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Financial incentives influence behavioural changes and the current review was done to assess the effectiveness of this intervention in improving HIV care continuum. We conducted systematic searches in MEDLINE, Cochrane library, ScienceDirect and Google Scholar from inception until July 2019. We carried out a meta-analysis with random-effects model quantifying inconsistency (I2) for heterogeneity and reported pooled Risk Ratios (RR) with 95% confidence intervals (CIs). A total of 22 studies with 38,119 participants were included. All the six outcomes showed better results in financial incentive arm compared to standard care with statistical significance in three outcomes—HIV testing uptake (pooled RR: 2.42; 95%CI 1.06–5.54; I2 = 100%), antiretroviral therapy (ART) adherence (pooled RR: 1.30; 95%CI 1.13–1.50; I 2 = 44%), and continuity in care (pooled RR: 1.24; 95%CI 1.09–1.41; I2 = 86%). To summarize, financial incentives can be helpful in improving the uptake of HIV testing, ART adherence and continuity of care while it was better for achieving viral load suppression among studies conducted in high-income countries. Keywords Continuum of care · Financial incentive · Human immunodeficiency virus · Meta-analysis
Introduction World Health Organization (WHO) has estimated that the Human Immunodeficiency Virus (HIV) infection has a global prevalence of 0.8% and contributed to around 0.8 million deaths in 2018 [1]. The advanced stage of Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10461-020-03038-2) contains supplementary material, which is available to authorized users. * Yuvaraj Krishnamoorthy [email protected] Tanveer Rehman [email protected] Manikandanesan Sakthivel [email protected] 1
Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
State Program and Technical Manager, Cap TB project, AP/TS Unit, Solidarity and Action against The HIV Infection in India (SAATHII), Hyderabad, India
2
HIV—Acquired Immunodeficiency Syndrome (AIDS)— drastically reduces the quality of life of the patients to such an extent that it is considered to be one of the top five causes of disability-adjusted life years (DALYs) worldwide [2]. Major causes of HIV-related DALYs are HIV-tuberculosis (TB) co-infection, especially multidrug-resistant (MDR) TB, and maternal deaths aggravated by HIV/AIDS. To curtail these premature deaths and high risk of transmission, “Treatment as Prevention (TasP)” and HIV care continuum approaches have been deployed [3]. TasP decreases the burden of AIDS by earl
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