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

描述（由申请人提供）：拟建项目有三个目的。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，以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。可行的假设是，可以在城市垃圾中实施一个具有适度经济激励的项目，以避免性传播感染（STI），以激励安全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项目参与度和保留率。其次，它将获得CEI对主要结果的影响的估计：报告的避孕套使用情况和报告的性伴侣数量。我们的工作假设是存在剂量反应效应，即CEI逐渐升高的参与者会比对照组表现出更多的保护行为。我们假设较高的CEI水平与较高的安全套使用率和性伴侣数量的减少有关。第三，它将检查CEI对次要结果的影响程度：性传播感染事件和商业性交易的价格。工作的假设是，CEI治疗组的性传播感染率将降低，他们将面临更低的商业性交易价格。该试点试验将仅包括来自墨西哥城社区站点的18-25岁的MSW （n=300）。在完成基线措施后，所有参与者将参加一个标准的单次信息/预防研讨会（关于使用避孕套预防艾滋病毒/性传播感染的好处，以及避孕套谈判）。然后他们将被随机分为三组：对照组、治疗1组和治疗2组。在治疗1中（100人），只有在第6个月和第12个月没有性传播感染时，才会得到低奖励（每次200比索）。治疗2（100人）只有在第6个月和第12个月没有性传播感染时才能获得高额奖励（每次500比索）。对照组（100人）即使在6个月和12个月时没有性传播感染，也不会接受任何CEI。但是，每个人都会收到不便费（在基线，第6个月和第12个月，每次70比索）。在第6个月和第12个月收到STI结果时，每个人都会有15-20分钟的强化课程，两个治疗组的人都会有CEI。性病检测和咨询将在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）合作，通过艾滋病毒研究联盟（CISIDAT）和布朗大学进行。

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.