POPS Chapter 25 - Tangible Reinforcements for HIV Prevention
Purpose: Tangible reinforcements can be useful tools for reaching underserved populations and engaging vulnerable communities to promote uptake of program services and/or behavioral health outcomes. Challenges to using tangible reinforcements include cost and the potential to attract repeat participants who are more interested in the reinforcement than the HIV programming and services. Contractors are encouraged to incorporate a variety of recruitment strategies and not rely solely on tangible reinforcements to attract and retain clients. Using a combination of strategies that appeal to multiple segments of the community will ultimately be more sustainable.
Contractors must develop a policy and procedure for the use of tangible reinforcements. Contractors should identify the most appropriate type of reinforcement and value (dollar amount), per population and intervention. An example may include providing a $25 gift card for participants who complete all sessions of an intervention. Contractors must consult with community advisory boards or individuals receiving services on appropriate reinforcements for HIV prevention services.
Use of tangible reinforcements are intended to:
- assist individuals living with HIV to engage and access services that will assist with linkage to medical care or engagement in other interventions designed to support HIV medication adherence and attain viral suppression; and
- assist individuals who are HIV negative, yet still vulnerable to HIV, to know their status and to engage in services and programming that provide a support network to incorporate harm reduction and safer sex options.
The policy must specify which activities qualify for tangible reinforcement. Contractors should reference the intervention or program manual for appropriate uses of tangible reinforcements. Examples include:
- Recruitment and retention of clients in HIV prevention interventions including HIV testing and linkage;
- Recruitment and retention of peer navigators;
- Encouragement for clients to return for HIV test results; and
- Participation in community assessments or focus groups;
The policy must also include safety and security measures in place to ensure tangible reinforcements are not lost or stolen.
Prior to purchasing and distributing tangible reinforcements, contractors must:
- Receive approval for tangible reinforcements in advance in writing by DSHS.
- have a line-item budget detailing the cost and type of tangible reinforcements to be used;
- conduct quality assurance activities to account for the proper use of tangible reinforcements; and
- ensure funds are not used to make cash payments or cash-equivalent payments to intended recipients of services except as noted above.
The following list are examples of allowable tangible reinforcements. This list is not intended to be all inclusive. Contractors should consult with the HIV Prevention program for further guidance.
- Transportation (bus token, rideshare)
- Gift cards (movie, food, and/or grocery gift cards; however, the purchase of tobacco or alcohol products is not allowed)
- Food (only allowed for client consumption in structural level interventions)
Contractors must create a log for tracking the purchase and distribution of tangible reinforcements. Every tangible reinforcement must have a unique identification number assigned to it. The policy and log are subject to review by DSHS during program reviews and at any other time.