Variable Rewards Incentives for ART Adherence in Uganda

描述(由申请人提供)：在撒哈拉以南非洲地区，当务之急是找到方法来改善护理中的保留率，并提高抗逆转录病毒治疗的依从性，因为那里的依从率已被发现随着时间的推移而下降，而且二线治疗等治疗选择非常有限。成功的干预措施需要考虑到这些国家的资源限制，能够加强对个人一生的坚持，并可以与其他经过验证的战略相结合。一个很有前途的工具是这项提案中建议的奖励遵守计划(RAP)，即使用分配给健康的艾滋病毒相关行为的小额奖励 被一幅画画着。这项干预旨在通过增加喜悦获奖的额外好处来增加已从事ART多年的成熟客户的动机，从而试图克服在平凡的日常药片占据终身治疗过程的背景下可能产生的治疗“疲劳”。来自行为心理学的见解，特别是操作条件反射，表明可变奖励的使用会导致对灭绝特别抵抗的行为的加强，即增加坚持 在很长一段时间内。拟议研究的第一阶段将使用定性访谈，以确保干预措施适应当地情况，并确定适当的干预参数。第二阶段将在一项随机对照试验中试行RAP测试，对象是使用ART至少两年并表现出依从性或保持问题的客户，因为正是这些客户的治疗疲劳可能成为问题。所有80名客户将获得MEMS上限，以记录遵守情况，并在12个月内(基线和此后每3个月)接受5项研究评估。对于干预组来说，过去一个月的及时就诊和药物补充将决定他们收到的赢得月度奖金的参赛作品的数量。给出最佳的遵守情况，每个参与者都有望在研究期间赢得两次奖项。研究的第三阶段调整RAP以解决第二阶段确定的局限性，并将其应用于对照组六个月。此外，将与提供者、实施者和研究参与者进行定性访谈，以了解实施困难和未来需要改进的领域。研究结果将为R01应用中更大、更严格的评估提供设计参数。

DESCRIPTION (provided by applicant): It is imperative to find ways to improve retention in care and boost ART adherence in sub-Saharan Africa where adherence rates have been found to decline over time and where treatment options such as second-line treatment are very limited. Successful interventions need to take the resource constraints in these countries into account, be able to bolster adherence over an individual's life-time, and can be combined with other proven strategies. A promising such tool is the Rewarding Adherence Program (RAP) suggested in this proposal, i.e. the use of small prizes for healthy HIV-related behavior allocated by a drawing. The intervention is targeted at increasing the motivation of mature clients who have been on ART for several years through the added benefit and joy of potentially winning a prize, thereby attempting to overcome the treatment 'fatigue' that can develop in the context of mundane, daily pill taking over the course of life-long treatment. Insights from behavioral psychology, in particular Operant Conditioning, suggest that the use of variable rewards results in reinforcement of behavior that is particularly resistant to extinction, i.e. increased adherence over long time periods. Phase 1 of the proposed study will use qualitative interviews to ensure adaptation of the intervention to the local context, and determine suitable intervention parameters. Phase 2 will pilot test RAP in a randomized controlled trial for clients who have been on ART for at least 2 years and who show adherence or retention problems, as it is these clients for whom treatment fatigue is potentially a problem. All 80 clients will receive MEMS caps to record adherence and five study assessments over 12 months (at baseline and every 3 months thereafter). For the intervention group, timely clinic attendance and drug refill over the past month will determine the number of entries they receive for winning a monthly prize. Given optimal adherence, each participant can expect to win a prize twice over the study period. Phase 3 of the study adapts RAP to address limitations identified in Phase 2 and applies it to the control group for six months. In addition, qualitative interviews will be conducted with providers, implementers, and study participants to learn about implementation difficulties and areas for future improvement. Study findings will inform the design parameters of a larger, more rigorous evaluation in an R01 application.