Conditional Economic Incentives for Improving Adolescent Adherence to HIV Treatment

提高青少年对艾滋病毒治疗依从性的有条件经济激励

• 批准号: 9198599
• 负责人: Omar Galarraga
• 金额: $ 18.72万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-05 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9198599
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adolescence; Adolescent; Adult; Affect; Africa South of the Sahara; Age; Area; Behavior; Behavior Control; Behavior Therapy; Behavioral; Calculi; Caregivers; Caring; Cessation of life; Child; Clinic; Clinical; Country; Decision Making; Development; Developmental Process; Distant; Drug resistance; Economics; Ensure; Environment; Epidemic; Exhibits; Face; Family; Fertility; Frequencies; Future; Generations; Goals; HIV; HIV Seropositivity; HIV drug resistance; HIV risk; Health; Health behavior; Horizontal Disease Transmission; Impulsivity; Incentives; Individual; Infection; Intervention; Interview; Knowledge; Life; Literature; Maintenance; Methods; Motivation; Outcome; Parents; Pattern; Pharmaceutical Preparations; Phase; Prevention; Prevention program; Provider; Quality of life; Research Design; Rewards; Risk; Risk Reduction; Risk-Taking; Science; South Africa; Staging; Surveys; Time; Vertical Disease Transmission; Viral; Viral Load result; adolescent patient; age group; antiretroviral therapy; behavioral economics; clinical practice; computerized; design; discount; driving behavior; economic incentive; efficacy trial; experience; habituation; high risk; improved; insight; medication compliance; novel strategies; patient oriented; preference; resistant strain; sexual debut; sexual relationship; success; theories; therapy adherence; therapy design; tool; transmission process; treatment program; willingness

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.

项目总结/摘要 坚持抗逆转录病毒疗法仍然是艾滋病毒治疗的主要挑战， 预防对于青少年来说，依从性是一个特别具有挑战性的问题， 与成人相比，青少年的依从性。然而，对于青少年来说， 坚持可以改善生活质量，延缓艾滋病的进展，减少横向或横向的风险， 垂直传播，并限制抗药性艾滋病毒的扩散。独特的发展转变， 发生在青春期的行为既可能带来挑战，也可能带来机遇，这表明需要 以健康为中心的干预。很少有行为干预措施是专门为青少年量身定制的 以青少年患者为中心的有条件经济激励措施（CEI）尚未被探索为 改善青少年坚持行为的方法。关于这个病人的理论前提- 一个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未来的折扣结果作斗争。以患者为中心的CEI 取决于行为或结果可以通过允许接受者立即体验到 积极健康行为的好处，而不是在遥远的未来改善健康的微弱回报。 青春期是利用CEIs的理想发育时间点，因为行为模式正在形成。 因此，在关键阶段短期提供CEI可能足以开始习惯行为 长期来看坚持是习惯化的理想行为。依从性文献表明， 青少年早期坚持抗逆转录病毒治疗预示着长期坚持。我们提出了一个定性的探索R21 一项研究，旨在调查CEI作为一种以药物为中心的方法在改善 南非-艾滋病流行最多、艾滋病毒阳性青少年人数最多的国家。我们 提出以下具体目标：（1）探讨青少年对艾滋病病毒感染者的接受程度和意愿 使用深入的个人访谈，包括如何定制CEI，以利用青少年 发展转型，包括增强独立性和责任感; CEI的频率可能会影响依从性;以及如何增强CEI依从行为的持久性 作为单独的干预措施或与其他干预措施结合使用;（2）探讨从 父母和艾滋病毒临床提供者如何家庭和诊所环境可以提高效果和持久性， 关于青少年依从性的CEI;（3）完善未来CEI干预的设计，并优化CEI， 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（目标1和2）纳入计算机化的定量 联合分析（目标3）。研究结果将推动艾滋病干预科学和临床实践， 艾滋病毒抗体阳性的年轻人将有可能活得更长、更健康。