Contingency Management Fact Sheet

Contingency management (CM) is a behavioral intervention that promotes healthy behavior using positive reinforcement in the form of rewards. Originally developed to treat substance use disorders, CM was adopted by public health practitioners and policymakers to help bring about a variety of positive health outcomes, including employment seeking behaviors, starting and continuing to take prescribed medications for the prevention of HIV, and remaining engaged in HIV care. The following brief, created by the California HIV/AIDS Policy Research Centers,  describes CM, key concerns, efficacy for use with people living with HIV, and people who use substances.

The full brief is also available for download at the bottom of this page. 

What is Contingency Management?
Contingency management (CM) is a behavioral intervention that promotes healthy behavior using positive reinforcement in the form of rewards. Originally developed to treat substance use disorders, CM was adopted by public health practitioners and policymakers to help bring about a variety of positive health outcomes, including employment seeking behaviors, starting and continuing to take prescribed medications for the prevention of HIV, and remaining engaged in HIV care. Rewards can be cash or cash-equivalent vouchers, vouchers for goods and services, or tickets for random draws from a pool of prizes. CM is called different names depending on one’s discipline; in public policy research, for example, CM involving financial incentives may also be referred to as “conditional cash transfers” or “conditional economic incentivization.”

How Does CM Work?
A premise of CM is that human behaviors are shaped by their consequences. Positive reinforcement such as economic incentives can be useful in encouraging healthy behaviors and ensuring they continue. CM can also help overcome errors in judgement that may lead to unhealthy behaviors. One such error is present-bias: the human tendency to place inordinate weight or focus on immediate concerns or rewards when making decisions.

To illustrate using HIV as a focus: patients may choose not to adhere to HIV medication for short-term benefit of non-adherence (e.g., avoiding stigma, reduced costs to access care, and reduction in medication side effects) over the substantial long-term benefits of staying in care (e.g., viral suppression, better overall health, and increased life expectancy). With incentives for behavior (i.e., HIV care visits) and biomarkers (i.e., viral load reduction), CM can provide immediate rewards for staying in care and, in doing so, lead to improved health outcomes.

Is CM efficacious for individuals living with HIV?
Several randomized controlled trials have assessed the efficacy of CM interventions to improve HIV-related outcomes. These studies have shown that financial incentives have led to improved retention in HIV care, and increased adherence to antiretroviral therapy (ART). Although results related to financial incentives to achieve viral load suppression have been mixed, a recent study published by a CHIPTS investigator found that CM combined with peer health navigation was associated with a 2.4-fold increase in the likelihood of viral suppression.

There is also evidence that CM can effectively address the needs of substance-using people living with HIV. When combined with psychotherapy, CM was associated with reduced cravings for methamphetamine among a cohort of HIV-positive sexual minority men. Further, CM, when combined with peer health navigation, was shown to improve ART among transgender women of color who are living with HIV.

Download the full brief: