Theme: Clinical Research Year: 2024
Background: Financial incentives are an effective intervention to enhance testing, and treatment for HCV infection. However, very few studies have investigated the impact of financial incentives that pay off government fines by engaging in healthcare-related activities. This study evaluated an incentivization intervention consisting of paying off or reducing government fines to increase HCV testing and treatment among at-risk people in New South Wales (NSW), Australia.
Methods: In this observational study, participants were tested and treated for HCV infection during ‘standard of care’ (January 2019-June 2021) and intervention (July 2021-December 2023) periods at a public health liver clinic in NSW, Australia. An intervention consisting of ‘Work and Development Orders’ to pay off NSW revenue fines was implemented in July 2021. Endpoints included numbers of people receiving HCV testing and proportion initiating treatment and achieving sustained virologic response (SVR, negative RNA >4 weeks post-treatment).
Results: Overall, 2,607 participants were tested (standard of care phase, 980; intervention phase, 1,617). Among people with current HCV infection, a higher treatment uptake was observed in the intervention phase (226 of 265, 85%) compared to the standard of care phase (279 of 382, 73%, p<0.001). Among people initiating treatment, a higher SVR was observed in the intervention phase (165 of 226, 73%) compared to the standard of care phase (159 of 279, 57%, p<0.001). This intervention paid off or reduced a total of AU$1,045,067 in fines (among 711 people; mean, $1,485 per person).
Conclusion: This study demonstrates that an incentive to pay off or reduce government fines increases HCV testing, treatment uptake, and SVR among people with HCV. Further research is needed to understand how a similar model could be applied in other settings and the cost-effectiveness of this approach for enhancing HCV testing and treatment.