Conditional Economic Incentives to Reduce HIV Risks: A Pilot in Mexico

简介(申请人提供)：该项目有三个目标。首先，它将测试有条件经济激励(CEI)计划的可行性和可接受性，该计划旨在激励墨西哥城男性性工作者(MSW)的自我保护和寻求医疗保健行为。工作假设是，可以在MSW中实施一个具有适度经济激励措施的计划，以避免性传播感染(STI)，以激励避孕套的使用和减少性伴侣。我们假设，与对照组相比，CEI治疗组将表现出更高的计划参与率和保留率。其次，它将获得CEI对主要结果的影响的估计：报告的避孕套使用和报告的性伴侣数量。我们的工作假设是，将存在剂量-反应效应，其中CEI逐渐升高的参与者将比对照组表现出更多的保护行为。我们假设CEI水平越高，报告的避孕套使用率越高，性伴数量就越少。第三，它将检查CEI对次要结果的影响程度：STI事件案例，以及商业性交易的价格。工作假设是，CEI治疗组的性病感染率将会降低，他们将面临更低的商业性交易价格。这项试点试验将只包括从墨西哥城社区网站招募的18-25岁的城市生活垃圾(n=300)。在完成基线措施后，所有参与者将参加标准的单节信息/预防讲习班(关于使用安全套预防艾滋病毒/性传播感染的益处和避孕套谈判)。然后他们将被随机分成三组：对照组、处理1和处理2。在处理1中，只有在6个月和12个月没有性传播感染的情况下，他们才能获得低激励(每次200比索)。处理2(100个人)只有在6个月和12个月没有性感染的情况下才得到高激励(500比索/次)。对照组(100个人)即使在6个月和12个月没有性传播感染，也不会得到任何CEI。然而，每个人都将收到不便费用(基线、6个月和12个月时每次70比索/次)。将有15-20分钟。在6个月和12个月收到STI结果时，对每个人进行强化治疗，并对任一治疗组的患者进行CEI。性传播感染检测和咨询将在Condesa诊所(墨西哥城最大的艾滋病毒诊所)与墨西哥公共卫生学院/国家公共卫生研究所(INSP)通过艾滋病毒研究联合体和布朗大学合作进行。 公共卫生相关性：目前应用的总体目标是实施一个试点项目，为墨西哥城男性性工作者(MSW)的艾滋病毒/性传播感染预防提供有条件的经济激励(CEI)，测试可行性和可接受性，并收集关于效果大小的初步证据，为未来的疗效试验提供参考。CEI是艾滋病毒预防的一种创新的结构性方法，到目前为止还没有在集中流行环境中进行测试。

DESCRIPTION (provided by applicant): The proposed project has three aims. First, it will test the feasibility and acceptability of a conditional economic incentives (CEI) program to incentivize self-protection and health-care-seeking behaviors among male sex workers (MSW) in Mexico City. The working hypothesis is that a program with modest economic incentives to stay free of sexually transmitted infections (STI) can be implemented among MSW to incentivize condom use and reduction of sex partners. We hypothesize that CEI treatment groups will exhibit greater program participation and retention rates as compared to the control group. Second, it will obtain estimates of the effect of CEI on primary outcomes: reported condom use and reported number of sexual partners. Our working hypothesis is that there will be a dose-response effect where participants with progressively higher CEI will show more protective behaviors than the controls. We hypothesize that higher levels of CEI will be associated with higher rates of reported condom use and greater reductions in the number of sex partners. Third, it will examine the degree to which CEI impact secondary outcomes: incident cases of STI, and prices for commercial sex transactions. The working hypothesis is that the CEI treatment groups will have reduced rates of STI and they will face lower prices for commercial sex transactions. This pilot trial will include MSW only, ages 18-25, recruited from community sites in Mexico City (n=300). After completing baseline measures, all participants will take part in a standard single-session information/prevention workshop (on the benefits of condom use for HIV/STI prevention, and condom negotiation). They will then be randomized into 1 of 3 groups: control, treatment 1 and treatment 2. In Treatment 1 (100 individuals) receive low incentive ($200 pesos/each time) only if they are free of STIs at months 6 and 12. Treatment 2 (100 individuals) receive high incentive ($500 pesos/each time) only if they are free of STIs at months 6 and 12. Controls (100 individuals) will not receive any CEI even if they are free of STIs at months 6 and 12. However, everyone will receive inconvenience fee ($70 pesos/each time at baseline, month 6 and month 12). There will be 15-20 min. reinforcing sessions for everyone at months 6 and 12 when receiving STI results, and CEI for those in either treatment group. STI testing and counseling will be conducted at Clinica Condesa (largest HIV clinic in Mexico City) in collaboration with the Mexican School of Public Health/National Institute of Public Health (INSP) through the Consortium of HIV Research (CISIDAT), and Brown University. PUBLIC HEALTH RELEVANCE: The overall objective of the current application is to implement a pilot project offering conditional economic incentives (CEI) for HIV/STI prevention among male sex workers (MSW) in Mexico City, to test feasibility and acceptability, and to gather preliminary evidence on effects sizes to inform a future efficacy trial. CEI are an innovative structural approach for HIV prevention, which so far has not been tested in concentrated epidemic settings.