Conditional Economic Incentives for Improving Adolescent Adherence to HIV Treatment

项目摘要/摘要 坚持抗逆转录病毒疗法(ART)仍然是艾滋病毒治疗和治疗的主要挑战 预防。坚持对青少年来说是一个特别具有挑战性的问题，这一点从显著降低的比率中可见一斑 与成年人相比，青少年的忠诚度更高。然而，对于青少年来说，坚持尤其重要 坚持可以提高生活质量，延缓艾滋病的进展，降低水平或水平的风险 垂直传播，限制抗药性艾滋病毒的扩散。独特的发展转型， 发生在青春期可能会给坚持下去带来挑战和机会，这表明有必要 以青少年为中心的干预措施。很少有行为干预是专门为青少年量身定做的 关于艺术。以青少年患者为中心的有条件经济激励(CEI)尚未被作为一种 改善青少年遵医行为的方法。这个病人的理论前提是- 以行为经济学为中心的方法是，个人决策往往有利于自我实现 但需要与眼前的满足感和贴现的未来结果作斗争。以患者为中心的CEIS 视行为或结果而定，可以通过允许接受者立即体验 积极的健康行为的好处，而不是在遥远的未来改善健康的较弱回报。 青春期是利用CEI的理想发展时间点，因为行为模式正在形成。 因此，在关键阶段短期提供CEI可能足以开始习惯化行为 从长远来看。坚持是一种习惯性的理想行为。遵守文献表明， 青春期早期对ART的坚持预示着长期的坚持。我们提出了一个定性的探索性R21 调查CEIS作为一种以青少年为中心提高依从性的方法的可接受性研究 南非--艾滋病疫情最严重的国家，也是感染艾滋病毒的青少年人数最多的国家。我们 提出以下具体目标：(1)探讨艾滋病毒阳性青少年的可接受性和意愿 通过深入的个人访谈使用CEIS，包括如何定制CEI以利用青少年 发展转型，包括提高独立性和责任感；数量、格式和 CEI的频率可能会影响坚持；以及如何提高CEI坚持行为的持久性 作为单独的干预措施或与其他干预措施结合使用；(2)从 父母和艾滋病毒临床提供者关于家庭和诊所环境如何增强治疗效果和持久性 CEIS对青少年的依从性；以及(3)完善未来CEI干预的设计，并优化CEIS 通过以用户为中心的干预设计开发，与其他有前途的干预措施相结合。我们 将定性确定的CEI偏好(来自目标1和2)纳入计算机化的量化 用联合分析进行调查(目标3)。这些发现将推动艾滋病毒干预科学和临床实践的发展 艾滋病毒阳性的年轻人将有可能活得更长、更健康。

PROJECT SUMMARY/ABSTRACT Adherence to antiretroviral therapy (ART) continues to present major challenges to HIV treatment and prevention. Adherence is a particularly challenging issue for adolescents, as seen by dramatically lower rates of adherence among adolescents compared to adults. Yet, adherence is especially vital for adolescents given that adherence can improve quality of life, delay progression towards AIDS, reduce risk for horizontal or vertical transmission, and limit proliferation of drug resistant HIV. The unique developmental transitions that occur during adolescence can pose both challenges and opportunities for adherence, suggesting the need for adolescent-centered interventions. Few behavioral interventions are specifically tailored by and for adolescents on ART. Adolescent-patient-centered conditional economic incentives (CEIs) have not yet been explored as an approach towards improving adherence behaviors among adolescents. The theoretical premise of this patient- centered and behavioral economic approach is that individual decision making often favors self-actualization but needs to contend with immediate gratification and discounted future outcomes. Patient-centered CEIs contingent on a behavior or outcome can alter this calculus by allowing recipients to experience immediate benefits of a positive health behavior rather than the weaker reward of improved health in the distant future. Adolescence is an ideal developmental timepoint to utilize CEIs since behavioral patterns are being developed. As such, short-term delivery of CEIs during a critical phase might be enough to start habituation of behaviors over the long term. Adherence is an ideal behavior for habituation. The adherence literature demonstrates that early-adolescent adherence to ART predicts long-term adherence. We propose a qualitative exploratory R21 study to investigate the acceptability of CEIs as an adolescent-centered approach for improving adherence in South Africa – the country with the largest epidemic, and the largest number of HIV-positive adolescents. We propose the following specific aims: (1) to explore with HIV-positive adolescents acceptability and willingness to use CEIs using in-depth individual interviews including how to tailor CEIs to capitalize on adolescent developmental transitions including increased independence and responsibility; how the amount, format and frequency of CEIs may influence adherence; and how to enhance durability of adherence behavior with CEIs used as a stand-alone intervention or in combination with other interventions; (2) to explore perspectives from parents and HIV clinical providers on how family and clinic environments can enhance effects and durability of CEIs on adolescent adherence; and (3) to refine design for a future CEI intervention and optimize CEIs in combination with other promising interventions through user-centered intervention design development. We incorporate qualitatively identified preferences for CEIs (from Aims 1 and 2) into a computerized quantitative survey with conjoint analysis (Aim 3). Findings will advance HIV intervention science and clinical practice for HIV-positive young people who will have the potential to live longer and healthier lives.