Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial

Summary Background Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission,...

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Bibliographic Details
Published in:The Lancet (British edition) 2014-07, Vol.384 (9938), p.153-163
Main Authors: Weaver, Tim, PhD, Metrebian, Nicola, PhD, Hellier, Jennifer, MSc, Pilling, Stephen, Prof, Charles, Vikki, MA, Little, Nicholas, MSc, Poovendran, Dilkushi, MSc, Mitcheson, Luke, DClinPsy, Ryan, Frank, D Psychol, Bowden-Jones, Owen, FRCPsych, Dunn, John, DM, Glasper, Anthony, MRCPsych, Finch, Emily, MD, Strang, John, Prof
Format: Article
Language:English
Subjects:
Addictions
Addictive behaviors
Adolescent
Adult
Biological and medical sciences
Clinical medicine
Female
General aspects
Hepatitis
Hepatitis B - prevention & control
Hepatitis B - psychology
Hepatitis B Vaccines - administration & dosage
Hepatitis B virus
Heroin
Heroin Dependence - psychology
Heroin Dependence - rehabilitation
Human viral diseases
Humans
Immunization
Incentives
Infections
Infectious diseases
Internal Medicine
Intervention
Male
Medical research
Medical sciences
Medication Adherence
Middle Aged
Motivation
Opiate Substitution Treatment - psychology
Patients
Prevention and actions
Public health
Public health. Hygiene
Public health. Hygiene-occupational medicine
Sensitivity analysis
Substance abuse treatment
Vaccination - methods
Vaccines
Viral diseases
Viral hepatitis
Young Adult
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Summary:Summary Background Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy. Methods In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493. Findings Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12·1, 95% CI 3·7–39·9; p
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(14)60196-3