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

提高长期服药依从性的激励和提醒 (INMIND)

• 批准号: 10082687
• 负责人: Sebastian Linnemayr
• 金额: $ 27.51万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082687
• 关键词: Adherence; Africa South of the Sahara; Anti-Retroviral Agents; Attention; Behavior; Behavioral; Car Phone; Caring; Chronic; Chronic Disease; Client; Clinic; Cognitive; Communities; Confidence Intervals; Control Groups; Counseling; Country; Cues; Data; Dose; Eating; Economics; Effectiveness of Interventions; Feedback; Focus Groups; Goals; HIV; Incentives; Intervention; Interview; Lead; Life; Literature; Measures; Mission; Motivation; Outcome; Participant; Patients; Phase; Prayers; Preparation; Professional counselor; Provider; Public Health; Randomized Controlled Trials; Reaction; Resources; Rewards; Structure; Surveys; Techniques; Testing; Text Messaging; Time; Toothbrushing; Translating; Treatment Efficacy; Viral; Viral Load result; Vulnerable Populations; Work; antiretroviral therapy; base; behavioral economics; cost; design; group intervention; health inequalities; improved; insight; intrinsic motivation; medication compliance; medication nonadherence; member; novel strategies; phase 2 testing; pill; preference; prevent; primary outcome; psychologic; relative effectiveness; response; secondary outcome; standard of care; therapy design; therapy development; treatment adherence

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.

项目摘要 最近，开始抗逆转录病毒治疗的人数（“治疗开始者”）有所增加， 太多的病毒不能抑制。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它们。现有的干预措施通常 这表明人们将目标行为锚到现有的常规，但未能支持参与者， 将行为转变为常规所需的时间，结果通常不到一半的人最终携带 目标行为自动退出。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惯例;它也表明两个容易 可实施的方法，以消除这些相同的偏见：偏见缺乏显着的慢性治疗 坚持（即随着时间的推移，日常生活中更紧迫的需求主导了良好的意图）可以通过以下方式来应对 通过移动的电话发送低成本的提醒信息，在这段时间内，把服药变成一种习惯 行为目前的偏见（即屈服于短期诱惑，这可能导致跳过药丸剂量）解释了 为什么很多人很难坚持他们的良好意愿。使用小的，间歇性的激励措施，直到 行为成为常规是一种新的方法，有可能成为建立游戏规则的改变者。 （目前难以实现的）长期高抗逆转录病毒治疗依从性的目标。拟议的R34研究将于 乌干达一家艾滋病诊所在治疗发起者中进行了一项为期12个月的随机对照试验（RCT）， 干预的可行性、可接受性和初步疗效。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，并收到一份传单， 将服药固定在现有的日常生活中。第一干预组的参与者（n=50）将接受 3个月的每日短信，以加强信息（消息组）。第二届会议的与会者 干预组（n=50）将收到相同的信息，但也将有机会赢得小 奖励条件是高度和及时的药物依从性（激励组）。对照组参与者 组将接受常规护理标准。依从性的持续性（主要结局）和及时服药- 在3个月的干预后，将使用MEMS帽测量9个月的服用量（次要结局）， 将在第12个月评估护理保留情况以及病毒载量（次要结局）。具体目标1 将评估INMIND的可行性和可接受性，并使用ADAPT制定干预措施- ITT框架。基于这些见解，具体目标2a和2b将检验 干预措施，包括两种不同的实施方法（即短信）的相对有效性 单独与基于BE的小激励一起）。具体目标3将收集数据， 后续R 01应用的干预参数，以大规模测试干预。