Strengthening the continuity of HIV care in Tanzania with economic support

通过经济支持加强坦桑尼亚艾滋病毒护理的连续性

• 批准号: 10463589
• 负责人: Sandra I McCoy
• 金额: $ 64.25万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10463589
• 关键词: AIDS prevention; Achievement; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Adult; Africa South of the Sahara; California; Caring; Child; Clinic; Collaborations; Community Developments; Consolidated Framework for Implementation Research; Continuity of Patient Care; Counseling; Country; Data; Development; Eastern Africa; Economics; Effectiveness; Effectiveness of Interventions; Elderly; Epidemic; Food; Gender; Goals; Government; HIV; HIV Infections; Health; Home; Home visitation; Incentives; Individual; Intervention; Interview; Investments; Knowledge; Longterm Follow-up; Machine Learning; Medical Records; Methods; Motivation; NIH Office of AIDS Research; Outcome; Participant; Persons; Pilot Projects; Poverty; Prevention; Prevention program; Provider; Randomized; Reporting; Research; Research Priority; Risk; Safety; Services; Southern Africa; Surveys; Tanzania; Testing; Time; Universities; Viral; Viral Load result; Visit; Vulnerable Populations; antiretroviral therapy; base; behavior change; behavioral economics; combat; comparison group; design; effectiveness evaluation; effectiveness implementation study; effectiveness measure; financial incentive; follow-up; implementation intervention; implementation research; improved; incentive program; incentive strategies; incentive-based intervention; markov model; mortality; motivated behavior; outreach; poverty reduction; process evaluation; programs; recruit; success; theories; therapy adherence; tool; treatment as prevention; treatment optimization

SUMMARY It is increasingly recognized that global goals for HIV epidemic control cannot be realized without improving retention in HIV care and adherence to antiretroviral therapy (ART). Only 58% of people living with HIV (PLHIV) in eastern and southern Africa are virally suppressed, and adherence counseling provided to those with elevated viral loads results in viral suppression only 40-50% of the time. Financial incentives, first used for poverty reduction, have been shown to motivate behavior change and improve engagement in HIV-related services. However, there is a paucity of data about the effectiveness of incentive-based programs for people who have disengaged from HIV care as well as the proactive use of incentives for PLHIV struggling with adherence. This research gap limits our understanding of whether financial incentive programs are worthwhile investments to support lifelong care, which is essential to the success of ‘treatment as HIV prevention’ (TasP). The proposed research will advance global knowledge about the effectiveness of financial incentives for strengthening the continuity of HIV care. We will build on data from a pilot study we conducted in Tanzania which found that an intervention offering a one-time financial incentive to out-of-care PLHIV was feasible, acceptable, and preliminarily efficacious at motivating re-engagement in HIV care. Leveraging our established research program and expertise with behavioral economics, we designed a 5-year, mixed-methods, hybrid effectiveness-implementation study to evaluate the financial incentive intervention and describe its successful implementation, with the ultimate goal of closing the gap towards achievement of UNAIDS’ ‘95-95-95’ goals. We will first assess if a one-time financial incentive improves re-engagement in care and durable viral suppression at 12 months among 640 PLHIV in Geita and Kagera Regions who have disengaged from care (Aim 1). We will then measure the effectiveness of short-term financial incentives offered to 692 in-care PLHIV who are at risk of loss to follow-up or poor adherence, with durable viral suppression at 12 months as the outcome (Aim 2). A mixed-methods study will describe implementation successes and challenges and synthesize lessons learned to inform adoption of incentive programs for vulnerable PLHIV (Aim 3). The project is a collaboration of the University of California, Berkeley, Health for a Prosperous Nation, Rasello, Management and Development for Health, and the Tanzania Ministry of Health, Community Development, Gender, Elderly, and Children. At the conclusion of the project, we will have rigorously evaluated the incentive strategy and will understand whether it can mitigate the persistent challenge of disengagement from HIV care, consistent with NIH Office of AIDS Research priorities for implementation research on retention in care and adherence to ART. This information is highly relevant to the spectrum of incentive-based programs being implemented or under consideration to improve the health of PLHIV and to optimize TasP programs in UNAIDS Fast Track countries. 1

概括 人们越来越认识到，在不改善的情况下，无法实现艾滋病毒流行控制的全球目标 保留艾滋病毒护理和遵守抗逆转录病毒疗法（ART）。只有58％的艾滋病毒患者 （PLHIV）在东部和南部非洲几乎被压制，并向那些提供遵守咨询 随着病毒载荷的升高，仅40-50％的时间导致病毒抑制。经济激励措施，首先用于 减少贫困，已被证明可以激励行为改变并改善与HIV相关的参与 服务。但是，关于基于激励计划的人的有效性的数据很少 谁脱离了艾滋病毒护理，并积极利用激励措施来努力 坚持。该研究差距限制了我们对财务激励计划是否值得的理解 支持终身护理的投资，这对于“作为预防艾滋病毒的治疗”的成功至关重要（TASP）。 拟议的研究将提高有关财务激励措施有效性的全球知识 加强艾滋病毒护理的连续性。我们将基于我们在坦桑尼亚进行的试点研究的数据。 这发现一项干预措施提供一次性的财务激励是可行的，是可行的， 可以接受的，并且在激励艾滋病毒护理中的重新参与方面有效。利用我们的建立 研究计划和行为经济学专业知识，我们设计了5年的混合方法，混合动力 有效实施研究以评估经济激励干预措施并描述其成功 实施，最终的目标是缩小实现UNAIDS '95 -95-95'目标的差距。我们 将首先评估一次性的经济激励措施是否改善了护理和耐用病毒抑制的重新参与 在Geita和Kagera地区的640个PLHIV中，已脱离护理的640个月中（AIM 1）。我们 然后，将衡量向692层提供的短期财务激励措施的有效性 随访或依从性差的损失风险，结果在12个月时耐用病毒抑制（AIM 2）。一项混合方法研究将描述实施成功和挑战并综合课程 学会了为弱势PLHIV的激励计划提供信息（AIM 3）。该项目是 加利福尼亚大学伯克利分校，一个繁荣国家的健康，拉塞罗，管理与发展 健康，坦桑尼亚卫生部，社区发展，性别，老年人和儿童。 在项目结束时，我们将严格评估激励策略，并将了解 它是否可以减轻与艾滋病毒护理的脱离接触的持续挑战，与NIH办公室一致 辅助研究对保留和遵守艺术的保留研究的重点。这 信息与实施或以下的基于激励的程序高度相关 考虑改善PLHIV的健康状况并优化UNAID快速国家 /地区的TASP计划的考虑。 1