Effectiveness of a short-term incentive program for HIV treatment adherence, retention, and re-engagement in care

摘要 人们越来越认识到，现金和实物激励可以激励行为改变和改善 沿着艾滋病毒护理连续体取得的成果。在适当的情况下，激励措施可以增加需求 在艾滋病毒检测方面，改变短期性行为，加强与艾滋病毒诊断后护理的联系，并促进 短期抗逆转录病毒治疗(ART)坚持。然而，缺乏长期的跟踪数据。 关于艾滋病毒感染者(PLHIV)的基于激励的计划。这一研究差距限制了我们的 了解这些方法是否值得投资，特别是在普遍的艾滋病毒方面 撒哈拉以南非洲的流行病。 这项拟议的研究将促进全球对抗逆转录病毒治疗激励的长期有效性的了解。 在护理中的坚持和保留，以及它们重新参与护理的潜在有效性。我们将在此基础上 我们在坦桑尼亚辛扬加进行的一项研究的初步数据发现，短期现金和食品 援助改善了食物不安全的PLHIV患者在6个月和12个月后对抗逆转录病毒治疗的依从性和保留率 跟进的问题。我们现在将利用我们已建立的研究计划来确定长期有效性 这些激励策略中。在我们为期两年的研究中，我们将首先确定24个月的遵从性和保留率 使用医疗和药学记录对781名在上一年末仍活着的PLHIV患者的结果 研究，在12个月的随访后结束(目标1)。然后，利用HOME的现有计划 在以医疗为基础的基础上，我们将确定无证转移和死亡的流行率 发现失访或转诊的患者。我们将使用这些家访数据来 调整干预措施在保留艾滋病毒护理和死亡率方面的有效性估计数(目标2)。在这些人中 发现PLHIV脱离护理，我们将进行一项一次性现金奖励的试点研究，以 鼓励艾滋病毒感染者重新参与护理，目的是减轻交通和卫生设施造成的障碍 机会成本(目标3)。 在项目结束时，我们将知道现金和食品激励对 依从性和保留性，以及它们是否也可以用于将PLHIV与CARE重新联系起来，数据高度相关 在“快车道”国家实施“全盘治疗”计划。这种及时的信息将广泛适用于频谱 目前正在设计、实施或正在考虑的基于激励的计划，以改善 人类免疫缺陷病毒的健康。此外，这项研究将帮助政策制定者理解基于激励的 这些方案应纳入正在进行的“作为预防的治疗”方案。 1

SUMMARY It is increasingly recognized that cash and in-kind incentives can motivate behavior change and improve outcomes along the HIV care continuum. Under the right circumstances, incentives can increase the demand for HIV testing, change short-term sexual behavior, enhance linkage to care after HIV diagnosis, and promote short-term antiretroviral therapy (ART) adherence. However, there is a paucity of long-term follow-up data about incentive-based programs for people living with HIV infection (PLHIV). This research gap limits our understanding of whether these approaches are worthwhile investments, especially in the generalized HIV epidemics in Sub-Saharan Africa. The proposed research will advance global knowledge about the long-term effectiveness of incentives for ART adherence and retention in care, and their potential effectiveness for re-engagement in care. We will build on preliminary data from a study we conducted in Shinyanga, Tanzania which found that short-term cash and food assistance improved ART adherence and retention in care among food insecure PLHIV after 6 and 12 months of follow-up. We will now leverage our established research program to determine the long-term effectiveness of these incentive strategies. In our 2-year study, we will first determine 24-month adherence and retention outcomes using medical and pharmacy records for the 781 PLHIV who were alive at the end of our previous study, which concluded after 12 months of follow-up (Aim 1). Then, leveraging an existing program of home based care, we will determine the prevalence of undocumented transfers and deaths among the subset of patients found to be lost to follow-up or transferred in clinic records. We will use these data from home visits to adjust estimates of the interventions' effectiveness on retention in HIV care and mortality (Aim 2). Among the PLHIV found to be disengaged from care, we will conduct a pilot study of a one-time cash incentive to encourage PLHIV to re-engage with care, with the goal of mitigating the barriers posed by transportation and opportunity costs (Aim 3). At the conclusion of the project, we will know the long-term effectiveness of cash and food incentives for adherence and retention, and whether they can also be used for re-linking PLHIV to care, data highly relevant to `Treat All' programs in Fast Track countries. This timely information will be widely applicable to the spectrum of incentive-based programs currently being designed, implemented, or under consideration to improve the health of PLHIV. Furthermore, this research will help policy makers understand whether incentive-based programs should be incorporated into ongoing `treatment as prevention' (TasP) programs. 1