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Variable Rewards Incentives for ART Adherence in Uganda

乌干达对 ART 坚持的可变奖励激励

基本信息

批准号：
8665496
负责人：
Sebastian Linnemayr
金额：
$ 21.78万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-07-26 至 2016-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8665496
关键词：
Accounting Address Adherence Africa South of the Sahara Anti-Retroviral Agents Antiretroviral resistance Applications Grants Appointment Area Awards and Prizes Behavior Behavioral Caring Cessation of life Chronic Disease Client Clinic Communities Control Groups Country Crowding Data Developing Countries Distant Dose Drops Economics Electronics Ensure Epidemic Ethics Evaluation Extinction (Psychology)Fatigue Feedback Focus Groups Frequencies Future Goals Grant HIV Health Benefit Healthcare Incentives Individual Intervention Interview Learning Life Life Cycle Stages Life Expectancy Logistics Maintenance Modeling Modification Monitor Motivation Operant Conditioning Participant Patient Self-Report Patients Perception Persons Pharmaceutical Preparations Pharmacy facility Phase Prize Procedures Provider Psychological reinforcement Psychology Public Health Randomized Controlled Trials Research Resistance Resources Rewards Role Schedule Testing Time Treatment Protocols Uganda antiretroviral therapy base cost effectiveness design group intervention human capital improved insight medication compliance phase 3 study pill primary outcome programs psychologic psychosocial screening secondary outcome skills success successful intervention theories therapy adherence therapy development tool treatment adherence

项目摘要

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.

描述（由申请人提供）：在撒哈拉以南非洲地区，迫切需要找到改善护理保留率和提高抗逆转录病毒治疗依从性的方法，因为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，并可以与其他经过验证的战略相结合。一个很有前途的工具是本提案中建议的奖励坚持计划（RAP），即对健康的艾滋病毒相关行为分配小额奖励