Innovative incentive strategies for sustainable HIV testing and linkage to care

可持续艾滋病毒检测和与护理联系的创新激励策略

• 批准号: 8992269
• 负责人: Gabriel Chamie
• 金额: $ 68.23万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-08 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8992269
• 关键词: AIDS prevention; Absenteeism at work; Acquired Immunodeficiency Syndrome; Adult; Affect; Africa South of the Sahara; Aftercare; Attention; Attitude; Behavior; Caring; Childbirth; Cluster randomized trial; Communities; Country; Decision Making; Diagnosis; Economics; Effectiveness; Ensure; Future; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health Care Seeking Behavior; Health behavior; Healthcare; Human immunodeficiency virus test; Incentives; Individual; Infection; International; Intervention; Interview; Investments; Left; Link; Low income; Motivation; Ownership; Pathway interactions; Pattern; Perception; Persons; Prevention; Prevention strategy; Prize; Probability; Psychology; Qualitative Research; Randomized; Randomized Controlled Trials; Research; Research Infrastructure; Research Methodology; Resources; Rewards; Risk; Rural; Sampling; Scientific Advances and Accomplishments; Surveys; Testing; Time; Uganda; Visit; Weight; Woman; arm; base; behavioral economics; care seeking; comparative effectiveness; cost; cost effective; cost effectiveness; economic incentive; effective intervention; falls; high risk; high risk behavior; high risk men; improved; innovation; insight; male; men; novel; older men; preference; primary outcome; psychosocial; public health relevance; secondary outcome; success; theories; uptake

 DESCRIPTION (provided by applicant): Significant resources have been invested in HIV testing to date, yet over half of adults globally remain unaware of their HIV status. Men in particular fall well below international HIV testing targets and those at highest risk of HIV infection are often the least likely to participate in community-based mobile HIV testing efforts. HIV- infected men also link to care at lower rates than women. Both the male testing and linkage to care "gaps" pose a challenge for the implementation of combination HIV prevention strategies, including treatment as prevention (TasP). Identifying interventions to increase HIV testing among men - particularly those engaged in high-risk behaviors - is thus an HIV prevention priority in sub-Saharan Africa. Although economic incentives - the offer of economic rewards that are conditional on undertaking a certain action - have been found to be effective in modifying health behaviors in low-income countries, existing approaches to incentives have failed to incorporate prominent insights from behavioral economics, leaving room for "smarter" incentive-based interventions that can be more effective and less expensive in increasing uptake of HIV testing and linkage to care. The long-term sustainability and cost-effectiveness of such interventions have also yet to be clearly established. This study will implement and evaluate novel incentive-based interventions to increase HIV testing among high-risk men and link HIV-infected adults to treatment. Aim 1 will build on insights from behavioral economics theories and studies, and test the premises that (1) incentives in the form of lotteries, with smal probabilities of winning high-value prizes as a result of HIV testing, may be more powerful than small, fixed incentives for HIV testing; and (2) individuals display "loss aversion (a reluctance t lose something they already own) and therefore are less motivated by the possibility of gaining something from HIV testing (i.e. a standard fixed incentive) than the possibility of losing something from not testing. The lottery-based incentives are likely to be most appealing to individuals with risk-seeking preferences, thereby ensuring that HIV testing is promoted in a targeted and inexpensive manner. Lottery and loss aversion-based incentives will be compared to fixed incentives, in a three-arm, randomized controlled trial. Aim 2 will draw upon the existence of loss aversion in individuals' decision-making patterns to examine whether men who test HIV-positive are more likely to link to care if the incentive offered to them features a saliet, immediate benefit to early linkage. Aim 3 will assess the sustainability and cost-effectiveness of novel economic incentives to increase testing by analyzing the effect of one-time incentives on subsequent HIV testing when incentives are no longer offered. The study will advance the scientific understanding of how and why incentives influence decision-making while also identifying low-cost, sustainable ways to increase demand for HIV testing among high-risk individuals, improve linkage to care, and ultimately facilitate the implementation of combination HIV prevention strategies.

 描述（由申请人提供）：迄今为止，已在艾滋病毒检测方面投入了大量资源，但全球仍有一半以上的成年人不知道自己的艾滋病毒状况。尤其是男子远远低于国际艾滋病毒检测目标，而那些感染艾滋病毒风险最高的人往往最不可能参加社区移动的艾滋病毒检测工作。感染艾滋病毒的男子也比妇女更少接受护理。男性检测和与护理“差距”的联系都对实施艾滋病毒预防综合战略，包括以治疗为预防构成挑战。因此，确定干预措施以增加男性-特别是那些从事高危行为的男性-的艾滋病毒检测是撒哈拉以南非洲艾滋病毒预防的优先事项。虽然经济激励措施--以采取某种行动为条件提供经济奖励--已被发现能有效地改变低收入国家的健康行为，但现有的激励措施未能纳入行为经济学的重要见解，为“更聪明”的激励留下空间-在增加艾滋病毒检测和与护理的联系方面，更有效和更便宜的基于基础的干预措施。这些干预措施的长期可持续性和成本效益也有待明确确定。这项研究将实施和评估新的基于激励的干预措施，以增加高危男性的艾滋病毒检测，并将艾滋病毒感染的成年人与治疗联系起来。目标1将建立在行为经济学理论和研究的基础上，并检验以下前提：（1）以彩票形式的激励，由于艾滋病毒检测而赢得高额奖金的可能性很小，可能比艾滋病毒检测的小额固定激励更有力;（2）个体表现出“损失厌恶（不愿意失去他们已经拥有的东西），因此不太愿意从艾滋病毒检测中获得一些东西（即标准的固定激励）而不是不测试而失去一些东西的可能性。抽奖式的激励措施可能对有冒险偏好的个人最具吸引力，从而确保以有针对性和低成本的方式促进艾滋病毒检测。在一项三臂随机对照试验中，将彩票和基于损失规避的激励措施与固定激励措施进行比较。目标2将利用个人决策模式中存在的厌恶损失现象，研究如果向艾滋病毒检测呈阳性的男子提供的奖励具有早期联系的显著、直接的好处，他们是否更有可能与护理联系起来。目标3将通过分析不再提供激励措施时一次性激励措施对后续艾滋病毒检测的影响，评估增加检测的新型经济激励措施的可持续性和成本效益。该研究将促进对激励措施如何以及为什么影响决策的科学理解，同时还确定低成本，可持续的方法来增加高风险人群对艾滋病毒检测的需求，改善与护理的联系，并最终促进艾滋病毒预防综合战略的实施。