Effectiveness of and best practices for using contingency management and incentives for health care issues related to HIV, sexually transmitted infections (STIs), and pre-exposure prophylaxis (PrEP)


  • Using contingency management and incentives at the different steps of HIV care continuum (such as testing, treatment adherence, viral suppressions) is widely explored and discussed in the literature, whereas the evidence related to other STIs or PrEP is more limited.
  • Many interventions have used incentives to increase rates of HIV testing, treatment adherence, and viral suppression among people who use drugs, individuals requiring psychosocial supports, and hardest-to-reach populations.
  • Recommendations for organizations considering the use of financial incentives include: incorporating incentives into HIV care programs; ensuring incentives meet the needs of the target population; framing incentives so they do not seem paternalistic or condescending; targeting individuals facing barriers to HIV adherence; and ensuring acceptance for the use of incentives across the entire organization.
  • Small-scale studies found that incentives can encourage STI testing among youth and can improve access to STI testing and treatment among hard-to-reach populations.
  • A pilot trial in the U.S. examining the use of incentives for PrEP adherence was found to be feasible and acceptable and another trial found that incentives increased PrEP use among participants, indicating promise for future larger trials.
  • Across the studies, most recipients had positive opinions and high acceptability of contingency management and/or incentives and noted that: it provided them with motivation to adhere to their medication, they enjoyed taking the quizzes and having a chance at winning, felt that incentives showed that someone cared about them, and appreciated a non-stigmatizing, non-paternalistic approach to missed doses of antiretroviral therapy (ART). At the same time, some study participants believe that individuals should be self-motivated to engage in HIV care and noted conflicting feelings of receiving payments for treatment adherence. Incentives may have the greatest impact among those starting ART or those without adherence routines, may be insufficient for those facing many barriers, and may not be necessary for those with intrinsic commitment to adherence.


The Ontario HIV Treatment Network: Rapid Response Service




  • Population(s)
    • General HIV+ population
    • General HIV- population
  • Prevention, Engagement and Care Cascade
    • Engagement and Care Cascade
    • Prevention
  • Engagement and Care Cascade
    • Linkage/engagement in care
    • Retention in care
    • Treatment
  • Prevention
    • Biomedical interventions
  • Testing
    • Testing
  • Co-infections
    • Hepatitis B, C
  • Health Systems
    • Delivery arrangements


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