Effectiveness of a short-term incentive program for HIV treatment adherence, retention, and re-engagement in care

针对艾滋病毒治疗依从性、保留性和重新参与护理的短期激励计划的有效性

• 批准号: 9560641
• 负责人: Sandra I McCoy
• 金额: $ 16.14万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-15 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9560641
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Adult; Adverse effects; Africa South of the Sahara; Appointment; Authorization documentation; Back; Caring; Cessation of life; Clinic; Clinic Visits; Clinical; Consent; Continuity of Patient Care; Counseling; Country; Data; Democratic Republic of the Congo; Economics; Effectiveness; Effectiveness of Interventions; Enrollment; Epidemic; Failure; Food; Future; Goals; HIV; HIV Infections; HIV diagnosis; Health; Home environment; Home visitation; Household; Human immunodeficiency virus test; Incentives; Individual; Intervention; Interview; Investments; K-Series Research Career Programs; Knowledge; Link; Measures; Medical; Medical Records; Outcome; Participant; Patient Transfer; Patients; Pharmaceutical Preparations; Pharmacy facility; Pilot Projects; Policy Maker; Poverty; Prevalence; Prevention program; Public Health; Randomized; Records; Research; Services; Sex Behavior; Tanzania; Time; Transportation; Uganda; United States National Institutes of Health; Update; Viral; Visit; Vital Status; antiretroviral therapy; base; behavior change; care providers; design; follow-up; improved; improved outcome; incentive program; incentive strategies; incentive-based intervention; mortality; motivated behavior; opportunity cost; patient subsets; programs; standard of care; systematic review; therapy adherence; tool; treatment adherence; willingness

SUMMARY It is increasingly recognized that cash and in-kind incentives can motivate behavior change and improve outcomes along the HIV care continuum. Under the right circumstances, incentives can increase the demand for HIV testing, change short-term sexual behavior, enhance linkage to care after HIV diagnosis, and promote short-term antiretroviral therapy (ART) adherence. However, there is a paucity of long-term follow-up data about incentive-based programs for people living with HIV infection (PLHIV). This research gap limits our understanding of whether these approaches are worthwhile investments, especially in the generalized HIV epidemics in Sub-Saharan Africa. The proposed research will advance global knowledge about the long-term effectiveness of incentives for ART adherence and retention in care, and their potential effectiveness for re-engagement in care. We will build on preliminary data from a study we conducted in Shinyanga, Tanzania which found that short-term cash and food assistance improved ART adherence and retention in care among food insecure PLHIV after 6 and 12 months of follow-up. We will now leverage our established research program to determine the long-term effectiveness of these incentive strategies. In our 2-year study, we will first determine 24-month adherence and retention outcomes using medical and pharmacy records for the 781 PLHIV who were alive at the end of our previous study, which concluded after 12 months of follow-up (Aim 1). Then, leveraging an existing program of home based care, we will determine the prevalence of undocumented transfers and deaths among the subset of patients found to be lost to follow-up or transferred in clinic records. We will use these data from home visits to adjust estimates of the interventions' effectiveness on retention in HIV care and mortality (Aim 2). Among the PLHIV found to be disengaged from care, we will conduct a pilot study of a one-time cash incentive to encourage PLHIV to re-engage with care, with the goal of mitigating the barriers posed by transportation and opportunity costs (Aim 3). At the conclusion of the project, we will know the long-term effectiveness of cash and food incentives for adherence and retention, and whether they can also be used for re-linking PLHIV to care, data highly relevant to `Treat All' programs in Fast Track countries. This timely information will be widely applicable to the spectrum of incentive-based programs currently being designed, implemented, or under consideration to improve the health of PLHIV. Furthermore, this research will help policy makers understand whether incentive-based programs should be incorporated into ongoing `treatment as prevention' (TasP) programs. 1

总结 人们越来越认识到，现金和实物激励可以激励行为改变和改善 沿着艾滋病毒护理连续体的成果。在适当的情况下，激励措施可以增加需求 艾滋病毒检测，改变短期性行为，加强艾滋病毒诊断后的护理联系，并促进 短期抗逆转录病毒治疗（ART）坚持。然而，缺乏长期随访数据 关于艾滋病毒感染者（PLHIV）的激励计划。这一研究空白限制了我们的 了解这些方法是否值得投资，特别是在广义的艾滋病毒 撒哈拉以南非洲的流行病。 拟议的研究将促进全球对ART激励措施长期有效性的认识 护理中的坚持和保留，以及他们重新参与护理的潜在有效性。我们将建立在 我们在坦桑尼亚辛扬加进行的一项研究的初步数据发现， 在6个月和12个月后，援助改善了粮食不安全的艾滋病毒感染者的抗逆转录病毒治疗依从性和继续接受护理的情况 的后续行动。我们现在将利用我们既定的研究计划，以确定长期的有效性， 这些激励策略。在我们为期2年的研究中，我们将首先确定24个月的依从性和保留率 结果使用医疗和药房记录的781 PLHIV谁是活着的结束时，我们以前的 研究，在12个月随访后结束（目标1）。然后，利用现有的家庭计划， 基于护理，我们将确定无证转移和死亡的流行率之间的子集， 发现失访或在临床记录中转移的患者。我们将使用这些数据从家访， 调整干预措施对艾滋病毒护理保留率和死亡率的有效性估计（目标2）。中 如果发现艾滋病毒感染者脱离护理，我们将进行一次性现金奖励试点研究， 鼓励艾滋病毒感染者重新参与护理，目标是减轻交通造成的障碍， 机会成本（目标3）。 在项目结束时，我们将知道现金和粮食奖励的长期有效性， 坚持和保留，以及它们是否也可用于将PLHIV与护理重新联系起来，数据高度相关 在快速通道国家实施“人人治疗”方案。这种及时的信息将广泛适用于频谱 目前正在设计，实施或考虑的激励计划，以改善 艾滋病毒感染者的健康。此外，这项研究将有助于政策制定者了解是否基于激励 应将这些方案纳入正在进行的“治疗即预防"方案。 1