Retrospective Cohort Study of Financial Incentives for STI Testing and Treatment in an Outreach Population in Edmonton, Canada, 2018-2019.

ABSTRACT

BACKGROUND: The incidence of sexually transmitted infections (STI) continues to increase worldwide. Patient incentives are one proposed intervention to increase STI testing and treatment. METHODS: We conducted a retrospective cohort study comparing incentivized versus routine care for STI outreach test and treat services between October 2018-June 2019. Incentivized care included a $10 gift card for testing visits and an additional $10 gift card for results and/or treatment visits. Incentivized visits were offered to clients with a lack of housing, who were difficult to locate, or had a history of being lost to follow-up. All test and treatment visits included chlamydia, gonorrhea, syphilis, and HIV testing and/or treatment by Registered Nurses and outreach workers from an STI Clinic. Outreach visits were offered at subsidized housing locations, community-based organizations, and street outreach. RESULTS: From October 2018 to June 2019, 2384 outreach clients were reached 453 (19.0%) receivedincentives and 1931 (81.0%) received routine care. There were no significant differences in case-finding rates for chlamydia (4.8%), gonorrhea (2.9%), and HIV (0.1%); however, there was for syphilis (3.8% for incentivized vs. 1.9% for routine visits; p = 0.02). All newly diagnosed infections identified in the incentivized group received treatment compared with routine visits (chlamydia 100% vs. 79.1%, p = 0.008, gonorrhea 100% vs. 59.7%, p = 0.002, and syphilis 100% vs. 86.7%, p = 0.08). CONCLUSIONS: Incentives were associated with increased case-finding rates of syphilis and were associated with 100% treatment rates. Incentives are a promising approach to decreasing the burden of STI among outreach populations.