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

摘要 人们越来越认识到，经济激励可以激励行为改变和改善结果 沿着艾滋病毒护理的连续体。在适当的情况下，财政激励可以增加对 艾滋病毒检测，改变短期性行为，加强与艾滋病毒诊断后护理的联系，并促进 坚持抗逆转录病毒疗法(ART)。然而，很少有关于现金转移对忠诚度的影响的研究 和/或在撒哈拉以南非洲的艾滋病毒携带者(PLHIV)中滞留，这是最大的 这是艾滋病毒的负担，并面临贫困和粮食无保障的长期挑战。 拟议的研究将通过建立在以下基础上，促进全球对艾滋病病毒现金转移的了解 初步数据来自我们在坦桑尼亚辛扬加进行的一项研究。研究发现，短期现金 转让可以改善粮食不安全的PLHIV患者对抗逆转录病毒治疗的依从性和保留率。我们现在将利用 我们制定了研究计划，以改进和严格评估我们的现金转移干预措施，这是 打算在治疗启动的脆弱时期提供短期支持，支持 养成良好的坚持习惯，保障个人和家庭的福利。在我们为期5年的研究中，我们 将首先在一项对519名PLHIV进行的随机研究中确定较小的现金转移是否可以改善 在12个月内保留护理和病毒抑制(目标1)。在选择了最佳现金转移规模后，我们 将在32个设施中实施一项整群随机试验，共1,984人感染艾滋病毒，以评估现金转移 干预其对12个月病毒抑制的有效性(目标2)。我们还将进行一次混合方式的 流程评估，以了解设施层面实施的成功和挑战(目标3)。贯穿始终 我们的项目，现金转移将通过创新和高效的mHealth系统交付，该系统克服了 手动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式，并 其有效性，与弥合证据和证据之间差距的实施科学方法相一致 在真实世界的背景下练习。这种及时的信息将广泛适用于现金转账的领域 目前正在设计、实施或正在考虑的改善艾滋病病毒感染者健康的计划。 此外，这项研究将帮助政策制定者了解是否应该纳入现金转移 纳入正在进行的“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.