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While making medications free can remove barriers to access for individuals who cannot pay for treatment, data suggest that for most people accessing care in industrialised countries, "making medications available for free or low cost will not solve problems with medication non-adherence," according to a presentation by Kevin Volpp from the University of Pennsylvania last week at IDWeek 2014 in Philadelphia, United States.
Volpp, a leading researcher on the impact of financial and organisational incentives on health behaviour and outcomes, described a range of other economic and behavioural incentives that could be used to reduce attrition along the HIV cascade of care – increasing the number of people tested and diagnosed with HIV who remain in care, take their antiretroviral medications, and have fully suppressed viral load.
Once effective treatments for conditions exist, individual behaviour is key to optimising outcomes using those treatments. Studies have shown that if the causes of premature mortality are divided into five domains – genetics, social circumstances, environmental exposures, behavioural patterns, and health care – behavioral causes account for nearly 40% of all deaths in the US. This suggests that the "single greatest opportunity to improve health and reduce premature deaths lies in personal behaviour."
But humans are not perfectly rational, and providing them with information about what to do or not do may not be enough to get them to do what is best for them – such as taking treatment that may save their lives. This is a universal problem that has been seen across many diseases.
Volpp also shared Centers for Disease Control and Prevention (CDC) data on the HIV care cascade that was described in other presentations at IDWeek, showing substantial attrition at each step of the continuum of care after diagnosis, so that of all the people who receive a diagnosis of HIV in the US, only 28% actually achieve viral suppression on antiretroviral therapy.
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