Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria.
Cost-effectiveness and feasibility of conditional economic incentives and motivational interviewing to improve HIV health outcomes of adolescents living with HIV in Anambra State, Nigeria.
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DOI：
10.1186/s12913-021-06718-4
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发表时间：
2021-07-11
影响因子：
2.8
通讯作者：
Eleje GU
中科院分区：
文献类型：
--
作者：
Ekwunife OI;Ofomata CJ;Okafor CE;Anetoh MU;Kalu SO;Ele PU;Eleje GU
在撒哈拉以南非洲，由于联系不紧密、继续接受艾滋病毒护理和坚持抗逆转录病毒疗法，青少年的死亡率和发病率不断上升。这是因为以卫生为中心的服务提供干预措施有限。这项成本效益和可行性研究是在一项集群随机试验的基础上进行的，该试验评估了以糖尿病为中心的服务提供干预措施的影响。服务提供干预措施审查了一项激励计划的影响，该计划包括有条件的经济激励措施和动机访谈对尼日利亚青少年艾滋病毒感染者的健康结果。从医疗保健提供者的角度进行了成本效益分析，以评估通过拟议的干预措施实现未检测到的病毒载量的每名额外患者的成本。使用增量成本效益比（ICER）估计了激励计划相对于常规护理的成本效益，ICER表示为实现不可检测病毒载量的成本/患者。我们进行了单变量敏感性分析，以检查关键参数对ICER的影响。对干预组的医护人员进行了深入访谈，以探讨在尼日利亚的艾滋病毒治疗医院实施服务提供干预的可行性。与常规护理相比，激励计划干预的ICER为每名病毒载量检测不到的额外患者1419美元。根据Woods等人提出的每质量调整生命年1137美元的成本效益阈值，2016年，干预措施不具有成本效益。敏感性测试显示，如果CD 4计数和病毒载量测试的频率从每季度减少到每三年，干预措施将具有成本效益。医疗保健专业人员报告说，患者对干预的接受程度非常高。有条件的经济奖励和动机性面谈不具有成本效益，但如果每年进行1-3次艾滋病毒生活质量指标检测，则可以具有成本效益。患者对干预的接受程度非常高。然而，医疗保健专业人士认为，除非政府承诺和医疗保健提供者的勤勉等因素得到适当解决，否则维持干预可能很困难。本试验通过WHO国际注册网络（PACTR 201806003040425）在WHO国际临床试验注册中心注册。在线版本包含补充材料，可通过10.1186/s12913-021-06718-4获得。
In sub-Saharan Africa, there is increasing mortality and morbidity of adolescents due to poor linkage, retention in HIV care and adherence to antiretroviral therapy (ART). This is a result of limited adolescent-centred service delivery interventions. This cost-effectiveness and feasibility study were piggybacked on a cluster-randomized trial that assessed the impact of an adolescent-centred service delivery intervention. The service delivery intervention examined the impact of an incentive scheme consisting of conditional economic incentives and motivational interviewing on the health outcomes of adolescents living with HIV in Nigeria. A cost-effectiveness analysis from the healthcare provider’s perspective was performed to assess the cost per additional patient achieving undetected viral load through the proposed intervention. The cost-effectiveness of the incentive scheme over routine care was estimated using the incremental cost-effectiveness ratio (ICER), expressed as cost/patient who achieved an undetectable viral load. We performed a univariate sensitivity analysis to examine the effect of key parameters on the ICER. An in-depth interview was conducted on the healthcare personnel in the intervention arm to explore the feasibility of implementing the service delivery intervention in HIV treatment hospitals in Nigeria. The ICER of the Incentive Scheme intervention compared to routine care was US$1419 per additional patient with undetectable viral load. Going by the cost-effectiveness threshold of US$1137 per quality-adjusted life-years suggested by Woods et al., 2016, the intervention was not cost-effective. The sensitivity test showed that the intervention will be cost-effective if the frequency of CD4 count and viral load tests are reduced from quarterly to triannually. Healthcare professionals reported that patients’ acceptance of the intervention was very high. The conditional economic incentives and motivational interviewing was not cost-effective, but can become cost-effective if the frequency of HIV quality of life indicator tests are performed 1–3 times per annum. Patients’ acceptance of the intervention was very high. However, healthcare professionals believed that sustaining the intervention may be difficult unless factors such as government commitment and healthcare provider diligence are duly addressed. This trial is registered in the WHO International Clinical Trials Registry through the WHO International Registry Network (PACTR201806003040425). The online version contains supplementary material available at 10.1186/s12913-021-06718-4.
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影响因子：
0.4
作者：
Richardson, Luann
通讯作者：
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影响因子：
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作者：
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DOI：
10.1111/tmi.12517
发表时间：
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期刊：
Tropical medicine & international health : TM & IH
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