Behavioral Economics Incentives to Support HIV Treatment Adherence in Sub-Saharan Africa

项目摘要 当务之急是找到方法来提高保持率，提高撒哈拉以南非洲的抗逆转录病毒治疗依从性， 随着时间的推移，发病率会下降，在二线治疗方案等治疗选择 非常有限。一个有前途的工具是彩票激励设施治疗依从性（LIFT）计划 建议在这个建议，即使用小奖品的健康艾滋病毒相关的行为分配的抽奖。 LIFT基于申请人的R34“奖励坚持计划（RAP）”[R34 MH 096609]的结果 这证明了彩票激励艾滋病毒相关行为的可行性和可接受性，并建立了 初步疗效。目前的R 01应用将建立在这些有希望的结果的基础上，目的是a）使用 病毒载量作为生物学终点，由于成本原因未包括在R34中; B）确定在 完全有效的干预，包括两种不同方式实施彩票的比较功效 激励措施（激励依从性;激励及时就诊和抑制病毒）; c） 确定这两种执行模式的成本效益，作为对决策者的进一步投入。的 干预的目标是增加已经接受抗逆转录病毒治疗的治疗成熟的客户的动机， 几年来，通过潜在获奖的额外好处和喜悦，从而试图克服 治疗“疲劳”，可以在世俗的背景下发展，每天服用药丸的过程中，终身 治疗行为经济学的见解表明，这种干预可能特别有效 对于那些有当前偏见的人（即那些倾向于以短期诱惑为代价的人）， 更长期的好处），这是在R34研究中发现的艾滋病毒客户中普遍存在的。电梯将是 在330名接受抗逆转录病毒治疗至少两年的成年患者中实施，分为三组： 干预组，及时的诊所出勤率将决定他们获得的参赛作品数量， 每月奖金，参与者有资格获得基于病毒抑制的年度彩票。第二 治疗组将在高度证实的ART依从性方面受到激励，包括额外的年度 彩票对照组将接受常规标准治疗。所有参与者将获得MEMS帽， 记录24个月内的依从性和5次研究评估（基线时和此后每6个月）。 第一个具体目标是评估LIFT的有效性;第二个目标是比较 基于依从性组和翻修组直接激励病毒抑制的有效性， 随后可以被纳入临床护理，因为它不需要昂贵的设备，而是依赖于 仅根据诊所提供的信息。第三个具体目标是进行比较成本- 作为进一步的政策投入，对《劳工法》的两个干预部门进行了有效性分析。

Project Summary It is imperative to find ways to improve retention 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 regimens are very limited. A promising tool is the Lottery Incentives to Facility Treatment Adherence (LIFT) program suggested in this proposal, i.e. the use of small prizes for healthy HIV-related behavior allocated by a drawing. LIFT is based on the results of the applicant's R34 `Rewarding Adherence Program (RAP)' [R34 MH096609] that demonstrated feasibility and acceptability of lottery incentives for HIV-related behaviors, and established preliminary efficacy. The current R01 application will build on these promising results with the aim to a) use viral loads as biological endpoints that were not included in the R34 for cost reasons; b) establish efficacy in a fully powered intervention including comparative efficacy of two different ways of implementing the lottery incentives (incentivization of adherence; incentivization of timely clinic visits and viral suppression) and; c) establish the cost effectiveness of these two implementation modes as a further input for policy-makers. The intervention is targeted at increasing the motivation of treatment-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 economics suggest that such an intervention may be particularly effective for people with present bias (i.e. those who have a tendency to give in to short-term temptation at the cost of more long-term benefits) that was found to be prevalent among HIV clients in the R34 study. LIFT will be implemented among 330 adult clients who have been on ART for at least two years in three groups: for the first intervention group, timely clinic attendance will determine the number of entries they receive for winning a monthly prize, and participants are eligible for an annual lottery based on viral suppression. The second treatment group will be incentivized on high demonstrated ART adherence, including at an additional annual lottery. The control group will receive the usual standard of care. All participants will receive MEMS caps to record adherence and five study assessments over 24 months (at baseline and every 6 months thereafter). The first Specific Aim will be to evaluate the effectiveness of LIFT; the second aim is to compare the effectiveness of the adherence-based arm and the revised arm directly incentivizing viral suppression that subsequently could be incorporated into clinical care as it does not require costly devices and instead relies only on information available in the clinic. The third Specific Aims is to perform a comparative cost- effectiveness analysis of the two LIFT intervention arms as a further policy input.