Behavioral Economics Incentives to Support HIV Treatment Adherence in Sub-Saharan Africa

项目摘要 当务之急是找到提高保留率的方法，在撒哈拉以南非洲地区提高抗逆转录病毒治疗的依从性 人们发现，随着时间的推移，发病率会下降，而二线疗法等治疗方案 非常有限。一个很有前途的工具是彩票奖励设施治疗依从性(LIFT)计划 在这项建议中建议，即使用抽签分配的健康艾滋病毒相关行为的小奖。 Lift基于申请人的R34‘奖励遵守计划(RAP)’的结果[R34 MH096609] 这证明了为艾滋病毒相关行为提供彩票奖励的可行性和可接受性，并建立了 初步疗效。当前的R01应用程序将建立在这些有希望的结果基础上，目的是a)使用 病毒载量作为生物终点，由于成本原因没有包括在R34中；b)在 全面干预包括两种不同方式实施彩票的效果比较 激励措施(激励遵守；激励及时就诊和抑制病毒)和；c) 确定这两种实施模式的成本效益，作为政策制定者的进一步投入。这个 干预的目标是增加治疗的动机-已经接受抗逆转录病毒治疗的成熟客户 通过几年的额外收益和喜悦的潜在获奖，从而试图克服 可以在平凡的、每日服用的药片接管终身过程的背景下发展起来的治疗“疲劳” 治疗。来自行为经济学的见解表明，这样的干预可能特别有效 对于有目前偏见的人(即那些有向短期诱惑屈服的倾向的人) 更长期的好处)，在R34研究中发现，这在艾滋病毒客户中很普遍。电梯将会是 在330名接受抗逆转录病毒治疗至少两年的成年客户中实施，分为三组：第一组 干预组，及时就诊将决定他们收到的获奖作品的数量 每月奖励，参与者有资格获得基于病毒抑制的年度彩票。第二 治疗组将受到高度示范的ART坚持的激励，包括额外的年度 彩票。对照组将接受通常标准的护理。所有参与者将获得MEMS上限，以 记录遵守情况，并在24个月内进行5次研究评估(基线时和此后每6个月进行一次)。 第一个具体目标是评估Lift的有效性；第二个目标是比较 基于依从性的ARM和修订的ARM的有效性直接激励病毒抑制 随后可以纳入临床护理，因为它不需要昂贵的设备，而是依赖于 仅根据诊所提供的信息。第三个具体目标是执行比较成本- 对两个电梯干预部门进行有效性分析，作为进一步的政策投入。

Project Summary It is imperative to find ways to improve retention boost ART adherence in sub-Saharan Africa where adherence rates have been found to decline over time, and where treatment options such as second-line regimens are very limited. A promising tool is the Lottery Incentives to Facility Treatment Adherence (LIFT) program suggested in this proposal, i.e. the use of small prizes for healthy HIV-related behavior allocated by a drawing. LIFT is based on the results of the applicant's R34 `Rewarding Adherence Program (RAP)' [R34 MH096609] that demonstrated feasibility and acceptability of lottery incentives for HIV-related behaviors, and established preliminary efficacy. The current R01 application will build on these promising results with the aim to a) use viral loads as biological endpoints that were not included in the R34 for cost reasons; b) establish efficacy in a fully powered intervention including comparative efficacy of two different ways of implementing the lottery incentives (incentivization of adherence; incentivization of timely clinic visits and viral suppression) and; c) establish the cost effectiveness of these two implementation modes as a further input for policy-makers. The intervention is targeted at increasing the motivation of treatment-mature clients who have been on ART for several years through the added benefit and joy of potentially winning a prize, thereby attempting to overcome the treatment `fatigue' that can develop in the context of mundane, daily pill taking over the course of life-long treatment. Insights from behavioral economics suggest that such an intervention may be particularly effective for people with present bias (i.e. those who have a tendency to give in to short-term temptation at the cost of more long-term benefits) that was found to be prevalent among HIV clients in the R34 study. LIFT will be implemented among 330 adult clients who have been on ART for at least two years in three groups: for the first intervention group, timely clinic attendance will determine the number of entries they receive for winning a monthly prize, and participants are eligible for an annual lottery based on viral suppression. The second treatment group will be incentivized on high demonstrated ART adherence, including at an additional annual lottery. The control group will receive the usual standard of care. All participants will receive MEMS caps to record adherence and five study assessments over 24 months (at baseline and every 6 months thereafter). The first Specific Aim will be to evaluate the effectiveness of LIFT; the second aim is to compare the effectiveness of the adherence-based arm and the revised arm directly incentivizing viral suppression that subsequently could be incorporated into clinical care as it does not require costly devices and instead relies only on information available in the clinic. The third Specific Aims is to perform a comparative cost- effectiveness analysis of the two LIFT intervention arms as a further policy input.