Effectiveness of periodic incentives on clinic attendance and hepatitis C testing and treatment for people who inject drugs: A five-year retrospective program evaluation

Abstract

Background

There is a significant global burden of chronic hepatitis C virus (HCV) infection, with many affected individuals, particularly people who inject drugs (PWID), not receiving testing and treatment. Financial incentives may increase HCV care uptake among PWID, but current evidence is limited. This study evaluated the effectiveness of routine financial incentives for clinic appointment attendance, HCV testing, and HCV treatment among PWID in Newcastle, Australia.

Methods

During twice-yearly 4–7-week periods from January 2016 to December 2020, people accessing a needle and syringe program were offered a gift card to attend a clinic appointment at the partnering sexual health service. Clinic records provided data on appointment attendance, HCV testing, and treatment initiation. Poisson regression and chi-square analyses were used to compare outcomes between incentive and non-incentive periods.

Results

Among the 1161 PWID who accessed the sexual health service during the study period, there were 4309 appointments attended and 1763 HCV tests undertaken. During the incentive periods, significantly more appointments (IRR 3.01, 95 % CI 2.74–3.31, p<.001) and HCV tests (IRR 5.02, 95 % CI 4.28–5.90, p<.001) occurred per week for PWID compared to the non-incentive periods. However, PWID were more likely to initiate HCV treatment during the non-incentive periods.

Conclusion

Integrating financial incentives into routine service delivery may be an effective strategy to increase clinic attendance and HCV testing among PWID. Further research is needed on optimising financial incentives for HCV treatment initiation.