New Jersey: HIV Clinic to Reward Poorer Patients for Taking Their Medicines

A Newark doctor is hoping to boost treatment adherence among his poor and minority HIV/AIDS patients by using incentives. At a new clinic in East Orange, Stephen Smith is offering $25 grocery coupons to patients whose tests indicate they have taken their treatments as prescribed for three consecutive months. Female patients can also receive help to pay for Pap smears and mammograms.

"We had a system that allowed us to check the level of HIV in the blood of patients and [viral load] just wasn't going down," said Stephen Smith, former medical director at the Peter Ho Memorial Clinic in Newark. "A colleague turned to me and asked, 'Why are we doing this?'"

More than 90 percent of poorer HIV/AIDS patients Smith saw at a Newark HIV/AIDS clinic were not taking the treatments as prescribed. He estimates that well over 90 percent of suburban HIV/AIDS patients adhere to their treatment regimen.

Surveys of medical providers cite homelessness, social stigma, lack of education and being uninsured as key obstacles to regimen adherence for poor and minority patients. The prevalence of HIV in certain US subpopulations now rivals rates seen for some sub-Saharan African countries, noted a recent New England Journal of Medicine article. HIV prevalence among Newark's black residents is comparable to that in Rwanda and Burundi, it showed.

"The needs for inner-city patients are very different for those in the suburbs," said Smith. "The socioeconomic equation is that it becomes prohibitive to think about the future. For them, it's next day, this week, next week. But if you get it right, treating HIV is easy now."

If the incentives program is successful, Smith hopes to expand it to a clinic opening in Newark this summer.

The full article, "AIDS in America -- Forgotten but Not Gone," was published in the New England Journal of Medicine (2010;362:967-970).

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