Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania.
Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania.
复制标题
DOI：
10.1097/qad.0000000000001406
复制
发表时间：
2017-03-27
期刊：
影响因子：
--
通讯作者：
Padian NS
中科院分区：
文献类型：
--
作者：
McCoy SI;Njau PF;Fahey C;Kapologwe N;Kadiyala S;Jewell NP;Dow WH;Padian NS
我们评估了短期现金和粮食援助对于提高坦桑尼亚艾滋病毒感染者 (PLHIV) 抗逆转录病毒治疗 (ART) 依从性和护理保留率的有效性。在三个诊所，805 名参与者按 3:3:1 的比例随机分为三组，按地点分层：营养评估和咨询 (NAC) 加现金转移（约 11 美元/月，n=347）、NAC 加食品篮（n=345）和仅 NAC（比较组，n=113，clinicaltrials.gov NCT01957917）。符合条件的 PLHIV 患者为：年龄≥18 岁、开始 ART ≤90 天且粮食不安全。现金或食物的提供时间≤连续 6 个月，以探视出席为条件。主要结局是 6 个月时药物持有率 (MPR) ≥95%。次要结果是 6 个月和 12 个月时的预约出勤率和失访率 (LTFU)。主要意向治疗分析包括 800 名参与者。与仅 NAC 组相比，NAC+现金组 6 个月时 MPR ≥ 95% 的实现率更高（85.0% vs. 63.4%），差异为 21.6 个百分点（95% 置信区间 (CI)：9.8、33.4，p<0.01）。 NAC+食物组的 MPR≥95% 也显着高于仅 NAC 组（差异=15.8，95% CI：3.8、27.9，p<0.01）。直接比较时，NAC+现金组和 NAC+食品组的 MPR≥95% 相似（差异=5.7，95% CI：-1.2、12.7，p=0.15）。与仅 NAC 相比，NAC+现金组和 NAC+食品组在 6 个月时的预约出勤率和 LTFU 均显着更高。 12 个月时，NAC+现金（而非 NAC+食品）对 MPR≥95% 和保留率的影响持续存在。短期有条件现金和粮食援助可提高坦桑尼亚 ART 拥有率和预约出勤率，并减少粮食不安全的 ART 发起者的 LTFU。
We evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy (ART) and retention in care among people living with HIV (PLHIV) in Tanzania. At three clinics, 805 participants were randomized to three groups in a 3:3:1 ratio, stratified by site: nutrition assessment and counseling (NAC) plus cash transfers (~$11/month, n=347), NAC plus food baskets (n=345), and NAC-only (comparison group, n=113, clinicaltrials.gov NCT01957917). Eligible PLHIV were: ≥18 years, initiated ART ≤90 days prior, and food insecure. Cash or food was provided for ≤6 consecutive months, conditional on visit attendance. The primary outcome was medication possession ratio (MPR) ≥95% at 6 months. Secondary outcomes were appointment attendance and loss to follow-up (LTFU) at 6 and 12 months. The primary intent-to-treat analysis included 800 participants. Achievement of MPR≥95% at 6 months was higher in the NAC+cash group compared to NAC-only (85.0% vs. 63.4%), a 21.6 percentage point difference (95% confidence interval (CI): 9.8, 33.4, p<0.01). MPR≥95% was also significantly higher in the NAC+food group versus NAC-only (difference=15.8, 95% CI: 3.8, 27.9, p<0.01). When directly compared, MPR≥95% was similar in the NAC+cash and NAC+food groups (difference=5.7, 95% CI: −1.2, 12.7, p=0.15). Compared to NAC-only, appointment attendance and LTFU were significantly higher in both the NAC+cash and NAC+food groups at 6 months. At 12 months, the effect of NAC+cash, but not NAC+food, on MPR≥95% and retention was sustained. Short-term conditional cash and food assistance improves ART possession and appointment attendance and reduces LTFU among food-insecure ART initiates in Tanzania.