Using Incentivization as a Strategy to Improve Implementation of a Motivational Interviewing Brief Intervention for Substance Use Disorders in HIV Settings: Results of a 26-Site Parallel Groups Cluster-Randomized Type-3 Hybrid Trial.
Paying staff $10 per brief MI doubled service delivery and cut client anxiety in HIV clinics, even if drug use stayed flat.
01Research in Context
What this study did
Garner et al. (2025) paid HIV-clinic staff $10 every time they gave a short motivational interview (MIBI) to clients with substance-use problems. They also paid another $10 if the session met a quality checklist.
Twenty-six clinics were split into two groups by coin flip. One group kept normal procedures. The other added the small cash rewards for staff.
What they found
The money doubled how many clients got the brief MI. Clients at pay-for-performance sites also felt less anxiety, even though their drug-use days stayed the same.
In plain numbers: twice as many sessions happened, and worry scores dropped, but substance use itself did not budge.
How this fits with other research
Winters et al. (2026) saw a similar pattern when they paid HIV patients, not staff. Ten dollars a month halved missed visits, yet the benefit vanished the day payments stopped. Garner’s staff incentives kept working while the money flowed, hinting that cash hooks behavior only while it is available.
Davidson et al. (2025) reviewed older trials that paid clients for clean drug tests. Those studies did cut drug use, especially for cocaine. Garner’s study did not track drug levels; they tracked service delivery. The different outcome makes sense because they reinforced staff work, not client abstinence.
Geurts et al. (2008) also used clinic-wide contingency management, but they rewarded clients for showing up. Again, attendance rose. Garner shifts the reward to the provider side and still lifts service rates, showing the lever can move either clients or staff.
Why it matters
If you run a clinic and want more evidence-based talks to happen, tiny staff bonuses work fast. Ten dollars per session is cheaper than retraining, and you will see the uptick in weekly data. Just plan for the fade: when the grant ends, keep an eye on counts so quality does not slip back to baseline.
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02At a glance
03Original abstract
To help improve the implementation of evidence-based substance use disorder (SUD) treatment in practice settings, the United States funds a support system called the Addiction Technology Transfer Center (ATTC) network. Prior implementation research in HIV care found the team-focused Implementation and Sustainment Facilitation (ISF) strategy as an effective addition to the ATTC's staff-focused training, feedback, and consultation (TFC) strategy. Using the ISF + TFC strategy as the control, this type-3 hybrid trial tested the effectiveness of adding a staff-focused incentivization (INC) strategy (ISF + TFC + INC vs. ISF + TFC). Staff-focused incentivization was selected because prior implementation research found it to be highly effective and cost-effective for improving SUD treatment implementation. Twenty-six HIV service organizations (HSOs), their staff participants (N = 87), and their client participants (N = 341) were cluster-randomized to either the ISF + TFC control condition or ISF + TFC + INC experimental condition. The INC strategy rewarded/reinforced motivational interviewing brief intervention (MIBI) implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined. The addition of the INC strategy had a large and significant (p < .05) effect on the number of MIBIs implemented (d = 1.30) and reduction in anxiety (d = −1.54). There was no significant impact on days of substance use. The addition a staff-focused INC strategy improved implementation of an evidence-based brief intervention for adults with comorbid HIV and SUD, and also reduced anxiety. To help improve the integration of evidence-based SUD services in HSOs across the United States, use of the ISF + TFC + INC strategy by the ATTC network and/or the AIDS Education and Training Center (AETC) network is recommended.
Implementation Research and Practice, 2025 · doi:10.1177/26334895251389475