Group-based economic incentives to improve adherence to antiretroviral therapy among youth living with HIV: safety and preliminary efficacy from a pilot trial.
Group-based economic incentives to improve adherence to antiretroviral therapy among youth living with HIV: safety and preliminary efficacy from a pilot trial.
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DOI：
10.1080/17450128.2019.1709678
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发表时间：
2020
影响因子：
1.1
通讯作者：
Barker DH
中科院分区：
文献类型：
--
作者：
Galárraga O;Enimil A;Bosomtwe D;Cao W;Barker DH
抗逆转录病毒治疗 (ART) 依从性差会对青少年产生严重后果。有条件经济激励（CEI）是一种可能有助于应对这一挑战的方法。本研究评估了基于小组的 CEI 计划的安全性和初步有效性，该计划旨在提高生活在加纳的青少年样本中的 ART 依从性。从 HIV 诊所招募了总共 35 名接受 ART 的青少年（平均年龄：14.7 岁），尽管病毒载量仍可检测，但被分为 5 个平衡组，在常规诊所就诊期间参加由同伴主导的基于小组的 CEI 活动。分别在基线和 3、6 和 9 个月随访时的四次就诊中进行了四项评估。主要结果是 ART 依从性和病毒载量。使用线性混合模型和主题分析进行数据分析。大多数（91.4%）参与者参加了所有四项干预活动。参与者报告在过去 7 天的基线、3、6 和 9 个月评估中平均分别缺少 1.06、0.50、0.91、0.55 剂 ART。大多数病毒载量在基线 (68.6%) 和 6 个月评估 (54.3%) 时均≥5,000 拷贝/ml。奖励分为就诊和完成评估的个人补偿（每人 5 美元，总共 20 美元）和价值 40 美元的基于团体的补偿，该补偿在 9 个月的评估期间根据平均团体出勤率（A≥90%、B≥75%、C≥60%、D<60%）和团体平均病毒载量（A=不可检测、B=50-499、C=500-4999、 D≥5,000）。参与者的平均收入为 46.70 美元（可能收入的 77.8%）。定性数据表明，CEI 通过获得个人和团体利益来帮助遵守 ART。参与者报告没有来自团体成员的戏弄、欺凌或其他不良行为。他们喜欢通过参加诊所/小组会议和获得无法检测到的病毒载量来获得金钱。我们的结论是，基于团体的 CEI 是安全的，并且有可能提高加纳青少年的 ART 依从性并减少病毒载量。
Poor adherence to antiretroviral therapy (ART) has significant consequences for adolescents. Conditional economic incentives (CEI) is an approach that may help address this challenge. This study evaluated the safety and preliminary efficacy of a group-based CEI program for ART adherence improvement among a sample of adolescents living in Ghana. A total of 35 adolescents (mean age: 14.7 years) on ART, though still with detectable viral load, were recruited from an HIV clinic and divided into 5 balanced groups to participate in peer-led group-based CEI activities during routine clinic visits. Four assessments were conducted across four visits at baseline and 3-, 6-, and 9-month follow-up, respectively. Main outcomes were ART adherence and viral load. Linear mixed models and thematic analysis were used for data analyses. The majority (91.4%) of the participants attended all four intervention activities. Participants reported missing an average of 1.06, 0.50, 0.91, 0.55 doses of ART in the past 7 days at baseline, 3-, 6-, and 9-month assessments, respectively. Most viral loads were ≥5,000 copies/ml at both baseline (68.6%) and 6-month assessments (54.3%). The incentive was divided between individual compensation for attending clinic and completing the assessment ($5 each, $20 in total) and a group-based compensation valued at $40 that was distributed during the 9-month assessment according to average group attendance (A≥90%, B≥75%, C≥60%, D<60%) and group-average viral load (A=undetectable, B=50–499, C=500–4999, D≥5,000). The mean earnings for the participants was $46.70 (77.8% of possible earning). Qualitative data suggested that the CEI helped ART adherence through gaining personal and group benefits. Participants reported no teasing, bullying, or other undesirable behaviors from group members. They liked getting money for attending clinics/group meetings and obtaining undetectable viral load. We concluded that a group-based CEI was safe and had the potential to improve ART adherence and reduce viral load among Ghanaian adolescents.