Promoting employment in persons living with HIV/AIDS

摘要 许多艾滋病毒/艾滋病感染者失业，估计数字表明失业率很高， 60%。失业导致生活质量下降，更大的抑郁症和物质使用，这是 与发病率和死亡率相关。虽然艾滋病毒/艾滋病感染者在获得和 维持就业，基于行为分析和行为经济学原理的干预措施可以 与最佳做法就业服务一起应用，以促进行为改变和改善结果。 这些干预措施包括提供基于货币的证据，以获得行为改变的客观证据。 它们可以成功地加强求职活动，即使是在高度边缘化和被剥夺权利的地区， 人口。这项研究将探讨加强就业活动的有效性，以改善 艾滋病毒/艾滋病感染者和艾滋病毒/艾滋病患者中希望以兼职或全职身份重返劳动力队伍的人的就业结果。总的来说， 这项研究将随机分配144名失业的艾滋病毒感染者/艾滋病患者接受两种干预措施之一。所有参与者将 接受通常的失业服务，重点是与艾滋病毒/艾滋病有关的具体问题， 鼓励完成面向就业准备和就业的活动。增强的 参与者将获得同样待遇，并有机会赢得1美元至100美元不等的奖品 与工作相关的活动。参与者将接受为期16周的研究治疗，并完成随访- 在18个月内进行评估。结构化评估将评估就业成果、生活质量 指数、身体和认知功能、心理症状、病毒载量以及药物使用和风险 行为。假设参与者在完成与工作相关的活动后会过渡到 以更高和更快的速度就业和工作更经常比那些谁是没有加强工作相关的 活动我们还希望强化干预能提高生活质量，减少抑郁， 症状，改善医疗效果。与标准护理条件相比，它还可以维持或 改善认知功能和药物依从性，减少传播传染病的危险行为 疾病我们将评估关键就业和健康结果的调节者和调解者， 强调探讨工作条件（临时、私下、实际或 （工作要求高，等等）影响心理社会和身体健康。我们将进行成本效益 分析，以估计这种干预措施如果有效，大规模传播的潜力。 !

Abstract Many persons living with HIV/AIDS (PLWHA) are unemployed, with estimates indicating rates as high as 60%. Unemployment results in lower quality of life, greater depression and substance use, and it is associated with morbidity and mortality. Although PLWHA face substantial challenges in obtaining and maintaining jobs, interventions based upon behavior analytic and behavioral economics principles can be applied alongside best practices employment services to enhance behavior change and improve outcomes. These interventions involve provision of monetary-based reinforcers for objective evidence of behavior change. They can successfully enhance job-seeking activities, even in highly marginalized and disenfranchised populations. This study will examine the efficacy of reinforcing job-acquisition activities for improving employment outcomes in PLWHA who desire to return to the workforce in part- or full-time capacity. In total, this study will randomly assign 144 unemployed PLWHA to one of two interventions. All participants will receive usual unemployment services with an emphasis on specific issues related to HIV/AIDS, plus encouragement for completing activities geared toward employment readiness and acquisition. The enhanced intervention will involve that same treatment plus chances to win prizes ranging from $1 to $100 for engaging in job-related activities each week. Participants will receive study treatments for 16 weeks and complete follow- up evaluations throughout 18 months. Structured evaluations will assess employment outcomes, quality of life indices, physical and cognitive functioning, psychological symptoms, viral loads, and drug use and risk behaviors. The hypothesis is that participants reinforced for completing job-related activities will transition to employment at higher and faster rates and work more often than those who are not reinforced for job-related activities. We also expect the reinforcement intervention will increase quality of life, reduce depressive symptoms, and improve medical outcomes. Compared to the standard care condition, it may also maintain or improve cognitive functioning and medication adherence and reduce risk behaviors that spread infectious diseases. We will evaluate moderators and mediators of key employment and health outcomes, with an emphasis on exploring the extent to which work conditions (temporary, under the table, physically or emotionally demanding jobs etc.) impact psychosocial and physical health. We will conduct cost-effectiveness analyses to estimate the potential for wide scale dissemination of this intervention if efficacious. !