Strengthening the continuity of HIV care in Tanzania with economic support

总结 人们日益认识到，如果不改善艾滋病毒/艾滋病的状况， 继续接受艾滋病毒护理和坚持抗逆转录病毒疗法。只有58%的艾滋病毒感染者 在东部和南部非洲，艾滋病毒感染者（PLHIV）受到病毒抑制，并为这些人提供依从性咨询。 病毒载量升高导致只有40-50%的时间的病毒抑制。财政奖励，首先用于 减贫，已被证明可以激励行为改变和改善参与艾滋病毒相关的 服务然而，关于激励计划对人们的有效性的数据很少。 那些已经脱离艾滋病毒护理的人，以及积极主动地使用激励措施， 坚持。这一研究空白限制了我们对财务激励计划是否值得的理解 投资以支持终身护理，这对“治疗即预防艾滋病毒”（TasP）的成功至关重要。 拟议的研究将促进全球对金融激励措施有效性的认识， 加强艾滋病毒护理的连续性。我们将以我们在坦桑尼亚进行的试点研究的数据为基础 该研究发现，为脱离护理的艾滋病毒感染者提供一次性经济激励的干预措施是可行的， 可以接受，并初步有效地激励重新参与艾滋病毒护理。利用我们现有的 研究计划和行为经济学的专业知识，我们设计了一个5年，混合方法，混合 有效性-实施研究，以评估财政激励干预措施，并描述其成功 执行，最终目标是缩小实现艾滋病规划署"95-95-95“目标的差距。我们 将首先评估一次性的经济激励是否能提高重新参与护理和持久的病毒抑制 在盖塔和卡盖拉地区，640名脱离护理的艾滋病毒感染者中，12个月时的感染率（目标1）。我们 然后，将衡量向692名在护理中的艾滋病毒感染者提供短期经济激励措施的有效性， 失访或依从性差的风险，以12个月时的持久病毒抑制为结局（目的 2）。一项混合方法研究将描述实施方面的成功和挑战，并总结经验教训 了解到为弱势艾滋病毒感染者采取激励方案提供信息（目标3）。该项目是一个合作， 加州大学伯克利分校，繁荣国家的健康，Rasello，管理与发展 卫生部和坦桑尼亚卫生、社区发展、性别、老年人和儿童部。 在项目结束时，我们将严格评估激励策略，并了解 它是否可以减轻脱离艾滋病毒护理的持续挑战，与NIH办公室一致， 艾滋病研究优先事项，以实施关于保持护理和坚持抗逆转录病毒疗法的研究。 信息是高度相关的频谱激励为基础的计划正在实施或根据 考虑改善艾滋病毒感染者的健康状况，并优化艾滋病规划署快速通道国家的TasP方案。 1

SUMMARY It is increasingly recognized that global goals for HIV epidemic control cannot be realized without improving retention in HIV care and adherence to antiretroviral therapy (ART). Only 58% of people living with HIV (PLHIV) in eastern and southern Africa are virally suppressed, and adherence counseling provided to those with elevated viral loads results in viral suppression only 40-50% of the time. Financial incentives, first used for poverty reduction, have been shown to motivate behavior change and improve engagement in HIV-related services. However, there is a paucity of data about the effectiveness of incentive-based programs for people who have disengaged from HIV care as well as the proactive use of incentives for PLHIV struggling with adherence. This research gap limits our understanding of whether financial incentive programs are worthwhile investments to support lifelong care, which is essential to the success of ‘treatment as HIV prevention’ (TasP). The proposed research will advance global knowledge about the effectiveness of financial incentives for strengthening the continuity of HIV care. We will build on data from a pilot study we conducted in Tanzania which found that an intervention offering a one-time financial incentive to out-of-care PLHIV was feasible, acceptable, and preliminarily efficacious at motivating re-engagement in HIV care. Leveraging our established research program and expertise with behavioral economics, we designed a 5-year, mixed-methods, hybrid effectiveness-implementation study to evaluate the financial incentive intervention and describe its successful implementation, with the ultimate goal of closing the gap towards achievement of UNAIDS’ ‘95-95-95’ goals. We will first assess if a one-time financial incentive improves re-engagement in care and durable viral suppression at 12 months among 640 PLHIV in Geita and Kagera Regions who have disengaged from care (Aim 1). We will then measure the effectiveness of short-term financial incentives offered to 692 in-care PLHIV who are at risk of loss to follow-up or poor adherence, with durable viral suppression at 12 months as the outcome (Aim 2). A mixed-methods study will describe implementation successes and challenges and synthesize lessons learned to inform adoption of incentive programs for vulnerable PLHIV (Aim 3). The project is a collaboration of the University of California, Berkeley, Health for a Prosperous Nation, Rasello, Management and Development for Health, and the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children. At the conclusion of the project, we will have rigorously evaluated the incentive strategy and will understand whether it can mitigate the persistent challenge of disengagement from HIV care, consistent with NIH Office of AIDS Research priorities for implementation research on retention in care and adherence to ART. This information is highly relevant to the spectrum of incentive-based programs being implemented or under consideration to improve the health of PLHIV and to optimize TasP programs in UNAIDS Fast Track countries. 1