Conditional Economic Incentives to Reduce HIV Risks: A Pilot in Mexico

描述（由申请人提供）：拟议的项目有三个目标。首先，它将测试的可行性和可接受性的有条件的经济激励（CEI）计划，以激励自我保护和寻求医疗保健的男性性工作者（MSW）在墨西哥城的行为。工作的假设是，适度的经济刺激方案，以保持免费的性传播感染（STI）可以在城市固体废物中实施，以鼓励使用避孕套和减少性伴侣。我们假设，与对照组相比，CEI治疗组将表现出更高的项目参与率和保留率。第二，它将获得估计的影响，CEI的主要成果：报告的避孕套使用和报告的性伴侣的数量。我们的工作假设是，将有一个剂量反应效应，参与者与越来越高的CEI将显示更多的保护行为比控制。我们推测，较高水平的CEI将与较高的避孕套使用率和性伴侣数量的减少有关。第三，它将研究CEI影响次要结果的程度：性传播感染事件和商业性交易的价格。目前的假设是，在实施了强制性教育的群体中，性传播感染的发病率将会降低，而且商业性交易的价格也会降低。该试点试验将仅包括从墨西哥城社区招募的18-25岁的城市固体废物（n=300）。在完成基线措施后，所有参与者将参加标准的单次信息/预防讲习班（关于使用避孕套预防艾滋病毒/性传播感染的好处，以及避孕套谈判）。然后将受试者随机分配至3组之一：对照组、治疗1组和治疗2组。在治疗1（100人）中，只有在第6个月和第12个月没有性传播感染的情况下，才能获得低奖励（每次200比索）。治疗2（100人）只有在6个月和12个月时没有性传播感染，才能获得高额奖励（每次500比索）。对照组（100名个体）将不接受任何CEI，即使他们在第6个月和第12个月没有STI。然而，每个人都将收到不便费（70比索/每次基线，第6个月和第12个月）。每个人在第6个月和第12个月收到STI结果时都会有15-20分钟的强化课程，任何一个治疗组的人都会有CEI。性病检测和咨询将在Clinica Condesa（墨西哥城最大的艾滋病毒诊所）与墨西哥公共卫生学院/国家公共卫生研究所（INSP）通过艾滋病毒研究联盟（CISIDAT）和布朗大学合作进行。 公共卫生相关性：当前申请的总体目标是实施一个试点项目，为墨西哥城男性性工作者（MSW）中的艾滋病毒/性传播感染预防提供有条件的经济激励（CEI），以测试可行性和可接受性，并收集有关效应大小的初步证据，为未来的疗效试验提供信息。CEI是预防艾滋病毒的一种创新的结构性方法，迄今尚未在集中流行的环境中进行测试。

DESCRIPTION (provided by applicant): The proposed project has three aims. First, it will test the feasibility and acceptability of a conditional economic incentives (CEI) program to incentivize self-protection and health-care-seeking behaviors among male sex workers (MSW) in Mexico City. The working hypothesis is that a program with modest economic incentives to stay free of sexually transmitted infections (STI) can be implemented among MSW to incentivize condom use and reduction of sex partners. We hypothesize that CEI treatment groups will exhibit greater program participation and retention rates as compared to the control group. Second, it will obtain estimates of the effect of CEI on primary outcomes: reported condom use and reported number of sexual partners. Our working hypothesis is that there will be a dose-response effect where participants with progressively higher CEI will show more protective behaviors than the controls. We hypothesize that higher levels of CEI will be associated with higher rates of reported condom use and greater reductions in the number of sex partners. Third, it will examine the degree to which CEI impact secondary outcomes: incident cases of STI, and prices for commercial sex transactions. The working hypothesis is that the CEI treatment groups will have reduced rates of STI and they will face lower prices for commercial sex transactions. This pilot trial will include MSW only, ages 18-25, recruited from community sites in Mexico City (n=300). After completing baseline measures, all participants will take part in a standard single-session information/prevention workshop (on the benefits of condom use for HIV/STI prevention, and condom negotiation). They will then be randomized into 1 of 3 groups: control, treatment 1 and treatment 2. In Treatment 1 (100 individuals) receive low incentive ($200 pesos/each time) only if they are free of STIs at months 6 and 12. Treatment 2 (100 individuals) receive high incentive ($500 pesos/each time) only if they are free of STIs at months 6 and 12. Controls (100 individuals) will not receive any CEI even if they are free of STIs at months 6 and 12. However, everyone will receive inconvenience fee ($70 pesos/each time at baseline, month 6 and month 12). There will be 15-20 min. reinforcing sessions for everyone at months 6 and 12 when receiving STI results, and CEI for those in either treatment group. STI testing and counseling will be conducted at Clinica Condesa (largest HIV clinic in Mexico City) in collaboration with the Mexican School of Public Health/National Institute of Public Health (INSP) through the Consortium of HIV Research (CISIDAT), and Brown University. PUBLIC HEALTH RELEVANCE: The overall objective of the current application is to implement a pilot project offering conditional economic incentives (CEI) for HIV/STI prevention among male sex workers (MSW) in Mexico City, to test feasibility and acceptability, and to gather preliminary evidence on effects sizes to inform a future efficacy trial. CEI are an innovative structural approach for HIV prevention, which so far has not been tested in concentrated epidemic settings.