Optimizing the efficiency and implementation of cash transfers to improve adherenceto antiretroviral therapy

1个摘要 2. 人们越来越认识到，经济激励可以激励人们改变行为，改善结果。 4沿着艾滋病毒护理连续体。在适当的情况下，财政激励可以增加对 5艾滋病毒检测，改变短期性行为，加强对艾滋病毒诊断后护理的联动，并促进 6坚持抗逆转录病毒治疗(ART)。然而，尽管针对艾滋病毒的现金转移研究激增 7预防在撒哈拉以南非洲，很少有关于现金转移对坚持和/或留存的影响的研究 8在撒哈拉以南非洲的艾滋病毒感染者(PLHIV)中。 9拟议的研究将促进关于艾滋病毒现金转移的全球知识，并校准 10最低现金转账规模，最佳投放策略，以及12个月后的病毒抑制效果。我们将建造 11基于我们进行的一项研究的初步数据，该研究表明，短期现金转移可以改善ART 12在坦桑尼亚，粮食不安全的艾滋病毒感染者坚持和保留护理。我们现在将利用我们的 13在坦桑尼亚建立了研究计划，以优化我们的短期(6个月)现金转移干预 14保留和遵守ART，以最大限度地提高效力，促进扩大规模。我们的总体目标是 15干预是在机会之窗进行短暂干预，以支持良好的发展 16坚持习惯，在治疗开始前的脆弱时期保护个人和家庭福利， 17并开发一个可以在现实世界中实施的现金转移系统。我们设计了一种高效的 18包含两项相关研究的研究计划，以微调干预措施及其实施，并确认其有效性 19关于最近ART启动者的护理保留和病毒抑制。我们将首先确定一个 20较小的现金转移可以在保留护理和病毒抑制方面实现类似的好处(目标1)。之后 21选择最佳现金转移规模，我们将在32个设施中实施整群随机试验，以：1) 22评估现金转移干预措施对12个月病毒抑制的有效性(目标2)；以及2)进行 23使用实施科学框架来理解设施级别的混合方法流程评估 24在通过移动保健系统实施干预措施方面的成功和挑战(目标3)。 25在项目结束时，我们将验证有效且可扩展的干预模型，并 26其有效性，与缩小证据和证据之间差距的执行科学方法相一致 27在现实世界的背景下练习。这种及时的信息将广泛适用于现金转账的领域 目前正在设计、实施或正在考虑的28个方案，以改善艾滋病病毒感染者的健康。

1 SUMMARY 2 3 It is increasingly recognized that financial incentives can motivate behavior change and improve outcomes 4 along the HIV care continuum. Under the right circumstances, financial incentives can increase the demand for 5 HIV testing, change short-term sexual behavior, enhance linkage to care after HIV diagnosis, and promote 6 antiretroviral therapy (ART) adherence. However, despite a proliferation of cash transfer studies for HIV 7 prevention in Sub-Saharan Africa, there are few studies of cash transfers’ effect on adherence and/or retention 8 among people living with HIV infection (PLHIV) in Sub-Saharan Africa. 9 The proposed research will advance global knowledge about cash transfers for PLHIV and calibrate the 10 minimum cash transfer size, best delivery strategy, and effect on viral suppression at 12 months. We will build 11 on preliminary data from a study we conducted demonstrating that short-term cash transfers can improve ART 12 adherence and retention in care among food insecure PLHIV in Tanzania. We will now leverage our 13 established research program in Tanzania to optimize our short-term (6 months) cash transfer intervention for 14 retention and ART adherence in order to maximize effectiveness and facilitate scale-up. The overall goal of our 15 intervention is to briefly intervene during a window of opportunity to support the development of good 16 adherence habits, protect individual and household welfare during the vulnerable time near treatment initiation, 17 and develop a cash transfer system that could be implemented in the real world. We have designed an efficient 18 research plan with two linked studies to fine-tune the intervention and its delivery and confirm its effectiveness 19 on retention in care and viral suppression among recent ART initiates. We will first determine whether a 20 smaller cash transfer can achieve similar benefits on retention in care and viral suppression (Aim 1). After 21 selecting an optimal cash transfer size, we will implement a cluster-randomized trial in 32 facilities to: 1) 22 evaluate the cash transfer intervention for effectiveness on 12-month viral suppression (Aim 2); and 2) conduct 23 a mixed methods process evaluation using an implementation science framework to understand facility-level 24 successes and challenges as they implement the intervention through the mHealth system (Aim 3). 25 At the conclusion of the project, we will have validated an efficient and scalable model of the intervention and 26 its effectiveness, consistent with an implementation science approach to close the gap between evidence and 27 practice in real-world contexts. This timely information will be widely applicable to the spectrum of cash transfer 28 programs currently being designed, implemented, or under consideration to improve the health of PLHIV.