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，必须找到改善护理保留率和提高抗逆转录病毒疗法依从性的方法，该地区的依从率随着时间的推移而下降，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，能够在个人的一生中加强坚持，并可以与其他行之有效的战略相结合。一个很有前途的工具是本提案中建议的奖励坚持计划，即对与艾滋病毒有关的健康行为分配小额奖励。 一幅画。干预措施的目标是通过可能获奖的额外好处和喜悦来增加已接受ART多年的成熟客户的动力，从而试图克服在终身治疗过程中日常服用药物的背景下可能产生的治疗“疲劳”。来自行为心理学的见解，特别是操作性条件反射，表明使用可变奖励会强化特别抵抗灭绝的行为，即增加坚持性 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对RAP进行试点测试，对象是已经接受ART至少2年并且表现出依从性或保留问题的客户，因为这些客户可能会出现治疗疲劳问题。所有80名客户都将收到MEMS帽，以记录12个月内的依从性和5次研究评估（基线和此后每3个月）。对于干预组，过去一个月及时的诊所出勤率和药物补充将决定他们获得每月奖金的参赛作品数量。在最佳坚持的情况下，每个参与者都可以在研究期间赢得两次奖品。研究的第三阶段采用RAP来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，还将与提供者、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改进的领域。研究结果将为R01应用程序中更大、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.