Background. Drug users (DUs), a population that accounts for some of the fastest growing HIV epidemics globally, lag behind other populations with regards to HIV-related outcomes. We evaluated the role of voucher incentives on linkage and retention in care among DUs in India. Methods. In this randomized clinical trial, 120 DUs who were ³ 18 years, HIV-infected, antiretroviral therapy (ART) naïve, ART-eligible and reported drug use in the prior month were randomized to incentive (INC) or control (CTL) conditions for 12 months. Participants randomized to the INC arm received incentives (redeemable for food/household goods) ranging in value from USD 4-8 for achieving pre-specified targets (e.g., ART initiation, visits to ART center). Subjects in CTL could win vouchers in prize-bowl drawings, but HIV care behaviors were not incentivized. The primary endpoint was time to ART initiation. Results. 60 participants each were randomized to INC and CTL between 12/2009 and 09/2010. Participants in the INC arm were more likely to visit the government ART center (49 vs. 33;p=0.002); 27 participants in the INC and 16 participants in the CTL arm initiated ART (p=0.04; hazard ratio for ART=2.33 (95% confidence interval [CI]: 1.15, 4.73]). Participants in the INC arm also had significantly more visits to the ART center (median number of visits: 8 vs. 3.5;p=0.005). However, no difference in viral suppression was observed. Conclusions. Modest voucher incentives improved linkage to and retention in HIV care, but did not significantly impact viral suppression among DUs in India, a disenfranchised hard-to-treat population.