Incentives and ReMINDers to Improve Long-term Medication Adherence (INMIND)

项目摘要 最近，开始抗逆转录病毒(ART)治疗(“治疗启动者”)的人数有所增加，但 太多的人未能实现病毒抑制。健康的日常生活是实现长期行为改变的关键 和健康的结果，但很少有人能自己形成这些结果。现有的干预措施通常 建议人们将目标行为固定在现有的例行公事上，但在 将这种行为变成例行公事所需的时间，结果通常不到一半的人最终携带 目标行为会自动发出。行为经济学(BE)指出了两个重要的偏见 许多人将他们的良好意图转化为成功的例行公事；这也很容易让人联想到两个 消除这些相同偏见的可实施方法：慢性治疗缺乏显着性的偏见 坚持(即随着时间的推移，更紧迫的日常生活需求主导了善意)可以通过 在将服药变成例行公事的过程中通过手机发送低成本的提醒消息 行为。目前的偏见(即屈服于短期诱惑，这可能导致跳过避孕药剂量)解释说 为什么很多人很难坚持他们的善意。使用小规模、间歇性的激励措施，直到 行为成为惯例是一种新的方法，它有可能改变游戏规则，建立 长期坚持高度艺术的目标(目前难以实现)。建议的R34研究将于#年实施。 乌干达一家HIV诊所在治疗启动者中进行了为期12个月的随机对照试验(RCT)，以建立 干预措施的可行性、可接受性和初步效果。在第一阶段的形成工作之后，所有 研究参与者将被告知常规服药的重要性，并收到一份宣传单，上面介绍了 将服药固定在现有的常规程序中。第一个干预组(n=50)的参与者随后将获得 连续3个月每天发短信，以加强这一信息(消息组)。第二组的参与者 干预组(n=50)将收到相同的消息，但也有机会赢得小 奖励条件是服药依从性高且及时(激励组)。控件中的参与者 小组将得到通常标准的护理。坚持坚持(主要结果)和及时服药- 在为期3个月的干预后，将使用MEMS CAPS测量服用(次要结果)9个月， 并将在12个月时评估护理中的滞留情况和病毒载量(次要结果)。 将评估INMIND的可行性和可接受性，并利用Adapt- ITT框架。基于这些见解，具体目标2a和2b将检验 干预，包括两种不同实施方法(即短信)的相对有效性 单独与以BE为基础的小型激励措施一起使用)。特定目标3将收集数据，使其能够适应 后续R01应用程序的干预参数，以测试规模的干预。

Project Summary Recently the number of people initiating antiretroviral (ART) treatment (“treatment initiators”) has increased but too many fail to achieve viral suppression. Healthy routines are key to achieving long-term behavioral change and healthy outcomes, but few people manage to form them on their own. Existing interventions typically suggest that people anchor the targeted behavior to an existing routine, but fail to support participants during the time it takes to turn the behavior into a routine, with the result that typically fewer than half end up carrying the targeted behavior out automatically. Behavioral economics (BE) points to two important biases preventing many people from translating their good intentions into successful routines; it also suggests two readily implementable approaches to counter these same biases: the bias of lack of salience of chronic treatment adherence (i.e. over time, the more pressing needs of daily life dominate good intentions) can be countered by low-cost reminder messages sent via mobile phone during the time it takes to turn pill-taking into a routine behavior. Present bias (i.e. giving in to short-term temptations, which can lead to skipping pill doses) explains why many people have trouble sticking to their good intentions. Using small, intermittent incentives until the behavior becomes a routine is a novel approach that has the potential to be a game changer for establishing the (currently elusive) goal of long-term high ART adherence. The proposed R34 study will be implemented in a Ugandan HIV clinic in a 12-month randomized controlled trial (RCT) among treatment initiators to establish feasibility, acceptability, and preliminary efficacy of the intervention. Following formative work in Phase 1, all study participants will be told about the importance of routine pill-taking and receive a leaflet with strategies for anchoring pill-taking to an existing routine. Participants in the first intervention group (n=50) will then receive daily text messages for 3 months to reinforce that information (Message group). Participants in the second intervention group (n=50) will receive the same messages, but will also have a chance of winning small rewards conditional on high and timely medication adherence (Incentive group). Participants in the Control group will receive the usual standard of care. Persistence of adherence (primary outcome) and timely pill- taking (secondary outcome) will be measured using MEMS caps for 9 months after the 3-months intervention, and retention in care as well as viral loads (secondary outcomes) will be assessed at month 12. Specific Aim 1 will be to evaluate the feasibility and acceptability of INMIND and develop the intervention using the ADAPT- ITT framework. Based on these insights, Specific Aims 2a and 2b will test the preliminary effectiveness of the intervention, including the relative effectiveness of two different implementation approaches (i.e. text messages alone vs. together with small BE-based incentives). Specific Aim 3 will collect data allowing adaptation of intervention parameters for a subsequent R01 application to test the intervention at scale.