One concern with setting a target such as total number of HIV tests administered means that providers have incentives to test people already tested recently (within the last three months, say) or people who have no risk.  There is some incentive to abuse the system for providers, in other words. Another problem with a pay for performance model is the risk that it might cause some adverse selection.  If there are performance measures for the percentage of HIV-positive patients on ARVs, for instance, there would be an incentive for providers not to take on new HIV-positive clients to ensure they are still meeting these sorts of ratio benchmarks.