Financial incentives to promote retention in care and viral suppression in adults with HIV initiating antiretroviral therapy in Tanzania: a three-arm randomised controlled trial.
Financial incentives to promote retention in care and viral suppression in adults with HIV initiating antiretroviral therapy in Tanzania: a three-arm randomised controlled trial.
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DOI：
10.1016/s2352-3018(20)30230-7
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
McCoy SI
中科院分区：
文献类型：
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作者：
Fahey CA;Njau PF;Katabaro E;Mfaume RS;Ulenga N;Mwenda N;Bradshaw PT;Dow WH;Padian NS;Jewell NP;McCoy SI
经济激励措施促进艾滋病毒服务的利用，并可能支持坚持抑制病毒所需的持续抗逆转录病毒治疗（ART），但很少有研究评估依从性的生物标志物或评估最佳实施情况。我们试图确定不同规模的就诊经济激励措施是否会影响坦桑尼亚开始接受 ART 的患者的病毒抑制。我们在 Shinyanga 地区进行了一项三臂平行组随机对照试验。在四家医疗机构，HIV 阳性成人（≥ 18 岁）开始接受 ART 治疗（≤ 30 天）时，使用基于平板电脑的应用程序（1:1:1，按地点分层）随机分配接受常规护理（对照组），或额外获得每月就诊的现金奖励，金额为以下两种金额之一：10000 TZS（约 4.50 美元）或 22500 TZS（约 10.00 美元）。参与者不知道两种激励规模的存在。通过移动医疗技术（mHealth）提供长达六个月的激励措施，该技术将生物识别出勤监控与自动移动支付联系起来。我们使用逻辑回归评估了六个月时保留病毒抑制护理（<1000 拷贝/毫升）的主要结果。这项已完成的试验已预先注册 (ClinicalTrials.gov NCT03351556)。从2018年4月24日到2018年12月14日，我们对530名患者进行了随机分组（184名对照患者；172名较小激励患者；174名较大激励患者）。所有参与者均纳入主要意向治疗分析。六个月时，对照组中约有 134 名参与者 (73.0%) 仍在接受护理并实现病毒抑制，而较小激励组中有 143 名参与者 (82.9%) [风险差异 (RD)=9.8，95% CI：1.2-18.5]，较大激励组中有 150 名参与者 (86.1%) (RD=13.0，95% CI：4.5-21.5)；尽管激励组没有显着差异（RD=3.2，95% CI：-4.6-11.0），但我们发现激励规模和病毒抑制之间存在正向趋势（P-趋势=0.0032）。不良事件包括对照组 7 例死亡 (4%) 和干预组 11 例死亡 (3%)，均与参与研究无关。使用移动医疗提供的小额经济激励措施可以提高开始艾滋病毒治疗的成年人的护理保留率和病毒抑制能力。虽然进一步的研究应该调查短期激励措施效果的持久性，但这些发现加强了在标准艾滋病毒护理中实施经济激励措施的证据。美国国立卫生研究院国家心理健康研究所。
Financial incentives promote utilization of HIV services and may support adherence to the sustained antiretroviral therapy (ART) necessary for viral suppression, but few studies have assessed a biomarker of adherence or evaluated optimal implementation. We sought to determine whether varying sized financial incentives for clinic attendance impact viral suppression among patients starting ART in Tanzania. We conducted a three-arm parallel-group randomised controlled trial in Shinyanga region. At four health facilities, HIV-positive adult (≥18 years) ART initiates (≤30 days) were randomly allocated using a tablet-based application (1:1:1, stratified by site) to receive usual care (control group) or to additionally receive a cash incentive for monthly clinic attendance in one of two amounts: 10000 TZS (≈US $4.50) or 22500 TZS (≈US $10.00). Participants were masked to the existence of two incentive sizes. Incentives were provided for up to six months via mobile health technology (mHealth) that linked biometric attendance monitoring to automated mobile payments. We evaluated the primary outcome of retention in care with viral suppression (<1000 copies per mL) at six months using logistic regression. This completed trial was pre-registered (ClinicalTrials.gov NCT03351556). From April 24, 2018 to December 14, 2018, we randomised 530 patients (184 control; 172 smaller incentive; 174 larger incentive). All participants were included in the primary intention-to-treat analysis. At six months, approximately 134 (73.0%) participants in the control group remained in care and achieved viral suppression, compared to 143 (82.9%) in the smaller incentive group [Risk Difference (RD)=9.8, 95% CI: 1.2–18.5] and 150 (86.1%) in the larger incentive group (RD=13.0, 95% CI: 4.5–21.5); we identified a positive trend between incentive size and viral suppression (P-trend=0.0032), although the incentive groups did not significantly differ (RD=3.2, 95% CI: −4.6–11.0). Adverse events included seven deaths (4%) in the control group and 11 deaths in the intervention groups (3%), none related to study participation. Small financial incentives delivered using mHealth can improve retention in care and viral suppression among adults starting HIV treatment. While further research should investigate the durability of effects from short-term incentives, these findings strengthen the evidence for implementing financial incentives within standard HIV care. National Institute of Mental Health at the US National Institutes of Health.