Incentives as a health promotion tool

Deadly Liver Mob uses an incentive-based peer-driven intervention model.

This approach is modelled on The Safe Injecting Cwiz (SIC) project that was conducted in Wentworth Area Health Service 1998-2002, which targeted people under the age of 25 years who injected drugs (Sheaves et al. 2001). The SIC project was an adaptation of the ECHO model, a HIV peer driven intervention for injecting drug users in the United States (Broadhead, Heckathorn, Grund, Stern, & Anthony, 1995; Sergeyev et al., 1999). These earlier projects provided the evidence to establish a focused, incentive-based education program that would reach deep into hidden and hard to reach networks.

There is also extensive evidence suggesting that incentives have benefits to health outcomes (e.g. see Boccia, Hargreaves, Lonnroth et al, 2011; Lagarde, Haines, Palmer, 2009; Parker, Bell, Currie et al, 2015; Seal, Kral, Lorvick et al, 2003; Topp, Day, Wand et al, 2013). You can read a literature review regarding incentives.

The peer-driven intervention model of the Deadly Liver Mob offers incentives to encourage clients to be educated then recruit and educate their peers. Their peers go to the Deadly Liver Mob program for education in the form of a conversation with the Aboriginal worker and to receive their incentive payment. The hepatitis C education sessions monitor the quality of peer messages and build on the client’s knowledge while dispelling any myths. A further incentive is offered to encourage program clients to undergo bloodborne virus and sexually transmissible infection  testing, to return for the results of these tests, and for other sexual health services (including hepatitis B vaccinations and treatment for STIs where positive test results are returned). The Deadly Liver Mob program does not offer incentives for hepatitis C  treatment, though this has been trialed elsewhere.




Boccia, D., et al. (2011). “Cash transfer and microfinance interventions for tuberculosis control: review of the impact evidence and policy implications.” Int J Tuberc Lung Dis, vol. 15 Suppl 2, pp. S37-49.

Broadhead, R. S., Heckathorn, D. D., Grund, J.-P. C., Stern, L. S., & Anthony, D. L. (1995). Drug Users versus Outreach Workers in Combating AIDS: Preliminary Results of a Peer-Driven Intervention. Journal of Drug Issues, vol. 25, no. 3, pp. 531-564.

Lagarde, M., et al. (2009). “The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries.” Cochrane Database Syst Rev, no. 4, Cd008137.

Lee, K. S., et al. (2020). “A financial incentive program to improve appointment attendance at a safety-net hospital-based primary care hepatitis C treatment program.” PloS One 15(2): e0228767.

Parker, R. M., et al. (2015). “‘Catching chlamydia’: combining cash incentives and community pharmacy access for increased chlamydia screening, the view of young people.” Aust J Prim Health, vol. 21, no. 1, pp. 79-83.

Seal, K. H., et al. (2003). “A randomized controlled trial of monetary incentives vs. outreach to enhance adherence to the hepatitis B vaccine series among injection drug users.” Drug Alcohol Depend, vol. 71, no. 2, pp. 127-131.

Sheaves, F, Preston, P, O’Neil, E, Klein, G & Hart, K. (2001). ‘That’s SIC: mobilizing youth for hepatitis C prevention’, Health Promotion Journal of Australia, vol. 12, no. 3, pp. 217-222.

Topp, L., et al. (2013). “A randomised controlled trial of financial incentives to increase hepatitis B vaccination completion among people who inject drugs in Australia.” Prev Med, vol. 57, no. 4, pp. 297-303.

Wohl, D. A., et al. (2017). “Financial Incentives for Adherence to Hepatitis C Virus Clinical Care and Treatment: A Randomized Trial of Two Strategies.” Open Forum Infectious Diseases 4(2).