Optimizing the efficiency and implementation of cash transfers to improve adherenceto antiretroviral therapy

总结 人们越来越认识到，经济激励可以激励行为改变，改善结果 沿着艾滋病护理的连续性。在适当的情况下，财政激励措施可以增加对 艾滋病毒检测，改变短期性行为，加强艾滋病毒诊断后护理的联系， 抗逆转录病毒治疗（ART）依从性。然而，关于现金转移支付对坚持的影响的研究很少 撒哈拉以南非洲艾滋病毒感染者（PLHIV）中， 艾滋病毒的负担，并面临着贫困和粮食不安全的持续挑战。 拟议的研究将通过建立在以下基础上，推动全球对艾滋病毒感染者现金转移的认识 我们在坦桑尼亚的辛扬加进行的一项研究的初步数据。研究发现，短期现金 转移可以改善粮食不安全的艾滋病毒感染者坚持抗逆转录病毒治疗和继续接受治疗的情况。我们现在要利用 我们已建立的研究计划，以改善和严格评估我们的现金转移干预，这是 打算在开始治疗的脆弱时期提供短期支助， 养成良好的坚持习惯，保护个人和家庭福利。在5年的研究中，我们 将首先在一项随机研究中确定519名艾滋病毒感染者是否可以通过较小的现金转移来改善 在12个月时保持护理和病毒抑制（目标1）。在选择最佳现金转移规模后，我们 将在32个有1,984名艾滋病毒感染者的设施中实施一项随机分组试验，以评估现金转移 干预其12个月病毒抑制的有效性（目标2）。我们还将进行混合方法 过程评价，以了解设施一级的实施成功和挑战（目标3）。在整个 我们的项目，现金转移将通过一个创新和有效的移动医疗系统，克服 人工分配现金转移的资源密集型流程。 在项目结束时，我们将确定一个有效和可扩展的干预模型， 其有效性，符合科学的实施方法，以缩小证据和 在现实世界的背景下实践。这种及时的信息将广泛适用于现金转移的范围 目前正在设计、实施或考虑的方案，以改善艾滋病毒感染者的健康。 此外，这项研究将有助于决策者了解是否应纳入现金转移支付 正在进行的“治疗即预防”（TasP）方案。

SUMMARY It is increasingly recognized that financial incentives can motivate behavior change and improve outcomes along the HIV care continuum. Under the right circumstances, financial incentives can increase the demand for HIV testing, change short-term sexual behavior, enhance linkage to care after HIV diagnosis, and promote antiretroviral therapy (ART) adherence. However, there are few studies of cash transfers' effect on adherence and/or retention among people living with HIV infection (PLHIV) in Sub-Saharan Africa, which has the greatest burden of HIV and faces persistent challenges with poverty and food insecurity. The proposed research will advance global knowledge about cash transfers for PLHIV by building on preliminary data from a study we conducted in Shinyanga, Tanzania. The study found that short-term cash transfers can improve ART adherence and retention in care among food insecure PLHIV. We will now leverage our established research program to improve and rigorously evaluate our cash transfer intervention, which is intended to offer short-term support during the vulnerable period of treatment initiation, support the development of good adherence habits, and protect individual and household welfare. In our 5-year study, we will first determine in a randomized study with 519 PLHIV whether a smaller cash transfer can improve retention in care and viral suppression at 12 months (Aim 1). After selecting the optimal cash transfer size, we will implement a cluster-randomized trial in 32 facilities with 1,984 PLHIV to evaluate the cash transfer intervention for its effectiveness on 12-month viral suppression (Aim 2). We will also conduct a mixed-methods process evaluation to understand facility-level implementation successes and challenges (Aim 3). Throughout our project, cash transfers will be delivered through an innovative and efficient mHealth system that overcomes the resource-intensive process of manually distributing cash transfers. At the conclusion of the project, we will have determined an efficient and scalable model of the intervention and its effectiveness, consistent with an implementation science approach to close the gap between evidence and practice in real-world contexts. This timely information will be widely applicable to the spectrum of cash transfer programs currently being designed, implemented, or under consideration to improve the health of PLHIV. Furthermore, this research will help policy makers understand whether cash transfers should be incorporated into ongoing `treatment as prevention' (TasP) programs.