Goals for Adherence with Low-cost Incentives (GOALS)

项目摘要 乌干达和其他地方艾滋病毒阳性青年的治疗结果受到低用药的威胁 坚持不懈。尽管在年轻人中显然需要坚持支持，但很少有干预措施针对这一点 在冒险行为加剧和未完成发展的时期，尤其是弱势群体 认知控制过程，如计划和目标导向行为。由行为激励提供信息 经济学(BE)已经成功地改变了一系列健康行为，通过对抗目前的偏见(The 过度低估预防性健康行为的未来好处的倾向)，包括我们自己的研究 提高了对艺术的坚持。然而，它们很少在感染艾滋病毒的青年中进行测试，这些人 考虑到他们在自我控制方面观察到的问题，他们可能特别受益于这种外在奖励。 要求个人达到统一的、高资格门槛的传统激励措施被排除在外 那些无法满足它的人，往往最需要支持。在一项初步研究中，我们测试了一种新的激励设计 即使是那些最初忠诚度较低的人也有资格获得激励，从而提高了他们的忠诚度。 BE理论认为，达到目标所付出的努力取决于它离参与者的距离有多远；如果 目标近在咫尺，参与者表现出实现目标的强烈意愿，但如果目标也设定了 兴奋时，S/他会失去动力，可能会放弃。基于这一认识，我们重新设计了我们的激励设计 允许参与者设置自己的资格门槛。我们建议以我们的试点结果为基础，使用 随机对照试验(RCT)以确定有效性。我们的干预，目标，建议测试 外部分配的子目标逐渐增加到90%(T1，n=140)，并自行选择、参与性 中期目标(T2，n=140)，而传统的固定目标为90%(T3，n=140)。对照组(n=140) 接受通常标准的护理。主要结果是收集到的电子测量的ART依从性 在整个研究过程中以及在取消激励措施后的12个月内衡量行为的持续性 改变；抑制病毒载量将是次要结果。第一年的具体目标(改进 阶段)是评估提高遵从性的三种激励方法的相对有效性 其中YLWH。在第二年(维护阶段)，我们测试以下三种方法的相对有效性 对保持坚守的激励。在第三年(持久期)，目标是调查12年 3个月三个目标干预在创造行为持续性方面的相对有效性 一旦取消激励措施。具体目标4是执行成本效益分析，包括 对比分析这些干预目标对提高干预效果的积极作用 和/或保持遵守。

Project Summary Treatment outcomes of HIV-positive youth in Uganda and elsewhere are threatened by low medication adherence. Despite the clear need for adherence support among youth, few interventions target this particularly vulnerable group during a time of heightened risk-taking behavior and unfinished development of cognitive control processes such as planning and goal-directed behavior. Incentives informed by behavioral economics (BE) have successfully changed a range of health behaviors by countering present bias (the tendency of overly discounting the future benefits of preventive health behaviors) including our own study that improved ART adherence. However, they have rarely been tested among youth living with HIV (YLWH) who are likely to particularly benefit from such extrinsic rewards given their observed problems with self-control. Traditional incentives that require individuals to reach a uniform, high eligible threshold by design leave out those unable to meet it, often most in need of support. In a pilot study, we tested a novel incentive design that allowed even those with low initial adherence to qualify for incentives, resulting in their improved adherence. BE theory suggests that the effort exerted to reach a goal depends on how far away it is from the participant; if the goal is within close reach, the participant shows great willingness to achieve it, but if the goal is set too high, s/he becomes demotivated and may give up. Based on this insight, we restructured our incentive design to allow participants to set their own eligibility threshold. We propose to build on our pilot results using a randomized controlled trial (RCT) to establish effectiveness. Our intervention, GOALS, proposes testing externally assigned sub-goals gradually increasing towards 90% (T1, n=140) and self-chosen, participatory interim goals (T2, n=140), against a traditional, fixed goal of 90% (T3, n=140). The control group (n=140) will receive the usual standard of care. The primary outcome is electronically measured ART adherence collected throughout the study and for 12 months after incentives are withdrawn to measure the persistence of behavior change; suppressed viral load will be the secondary outcome. The Specific Aims in year 1 (Improvement Phase) is to evaluate the relative effectiveness of the three incentivization approaches for improving adherence among YLWH. In year 2 (Maintenance Phase), we test the relative effectiveness of the three ways of incentivization for maintaining adherence. In year 3 (Persistence Phase) the goal is to investigate for 12 months the relative effectiveness of the three GOALS intervention arms at creating behavioral persistence once incentives are removed. Specific Aim 4 is to perform a cost-effectiveness analysis including a comparative analysis of those GOALS intervention arms that show a positive intervention impact for improving and/or maintaining adherence.