Understanding the Mechanism of Action of Cash and In-Kind Transfers to Improve the Health of People Living with HIV Infection in Tanzania

了解现金和实物转移改善坦桑尼亚艾滋病毒感染者健康的行动机制

• 批准号: 9139998
• 负责人: Sandra I McCoy
• 金额: $ 5.78万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-08 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9139998
• 关键词: AIDS prevention; Address; Adherence; Adult; Adverse effects; Affect; Aftercare; Alcohols; Businesses; Caring; Characteristics; Clinic Visits; Clinical; Continuity of Patient Care; Data; Data Collection; Decision Making; Education; Environment; Expenditure; Food; Food Processing; Funding; Future; Goals; HIV; HIV Infections; HIV diagnosis; Health; Heterogeneity; Household; Human immunodeficiency virus test; Incentives; Individual; Interview; K-Series Research Career Programs; Kenya; Knowledge; Life; Link; Malawi; Methods; Mexico; Motivation; Outcome; Parents; Pathway interactions; Population; Positioning Attribute; Poverty; Probability; Process; Randomized; Research; Rewards; Risk Behaviors; Self Determination; Sex Behavior; Sexual Health; Sexually Transmitted Diseases; Social Welfare; South Africa; Surveys; Tanzania; United States National Institutes of Health; Viral Load result; Woman; Work; antiretroviral therapy; base; behavior change; behavioral economics; design; expectation; financial incentive; follow-up; girls; improved; improved outcome; men; motivated behavior; programs; public health relevance; scale up; sex; theories; therapy adherence; young adult

 DESCRIPTION (provided by applicant): It is increasingly recognized that incentives can motivate behavior change and improve outcomes along the HIV care continuum. Under the right circumstances, financial incentives can increase the demand for HIV testing, change short-term sexual behavior, enhance linkage to care after HIV diagnosis, and promote antiretroviral therapy (ART) adherence. However, there are significant gaps in our understanding of the pathways through which incentives improve health, as well as whether they have unintended consequences and benefits. These knowledge gaps preclude definitive explanation of why incentives work in some programs but not others, and limit our understanding of which components to include in future programs. Understanding the mechanisms through which incentives change behavior and for whom they work best is essential in order to guide the scale-up of incentive-based programs in a variety of settings, including those targeting people living with HIV infection (PLHIV). We have the opportunity to address this knowledge gap by leveraging our ongoing study of short-term food and cash transfers for food insecure PLHIV in Shinyanga, Tanzania. This study includes food insecure PLHIV who are randomized to receive 6 months of food or cash transfers, conditional on clinic visit attendance, which is intended to reduce barriers to ART adherence and retention in care. The mixed-methods study proposed here explores unaddressed questions in the parent study and will use two complementary approaches in order to explore the pathways through which incentives operate. In Aim 1, we will conduct a qualitative study consisting of 32 in-depth interviews with PLHIV to explore the influence of personal, familial, and structural factors on the decision-making process of how food or cash assistance is utilized and how this influences adherence. In Aim 2, we will use quantitative survey data from 576 PLHIV to examine how food insecure PLHIV utilize food or cash assistance, whether there are unanticipated positive or negative outcomes, and whether the transfers' effect on adherence at 12 months is heterogeneous depending on the recipient's characteristics, such as motivation for being adherent and expectations about the future. At the conclusion of the research, we will have a better understanding of the mechanisms through which incentives may improve adherence to ART and retention in care. We will also know whether the incentives used in this setting had additional unintended benefits or adverse effects among PLHIV or their households. This timely information may be widely applicable to the spectrum of cash and in-kind assistance programs currently being designed, implemented, or under consideration to improve the health of PLHIV.

 描述（由申请人提供）：人们越来越认识到，激励措施可以激励行为改变并改善艾滋病毒护理连续过程的结果。在适当的情况下，经济激励措施可以增加对艾滋病毒检测的需求，改变短期性行为，加强联系。然而，我们对激励措施改善健康的途径以及它们是否会产生意想不到的后果和益处的理解存在重大差距。解释为什么激励措施在某些计划中起作用，而在其他计划中不起作用，并限制我们对未来计划中应包含哪些组成部分的理解。了解激励措施改变行为的机制以及它们对谁最有效，对于指导激励措施的扩大至关重要。各种环境下的项目，包括针对艾滋病毒感染者（PLHIV）的项目，我们有机会通过利用我们正在进行的针对辛扬加粮食不安全的艾滋病毒感染者的短期粮食和现金转移的研究来解决这一知识差距。这项研究包括粮食不安全。艾滋病毒携带者被随机接受 6 个月的食物或现金转移，条件是就诊，旨在减少 ART 依从性和保留护理的障碍。这里提出的混合方法研究探讨了家长研究中未解决的问题，并将使用两种互补的方法来探索激励措施的运作途径 在目标 1 中，我们将进行一项定性研究，其中包括 32 次对艾滋病病毒感染者的深入访谈，以探讨个人、家庭和结构因素对艾滋病毒感染者的影响。如何利用粮食或现金援助以及这如何影响依从性的决策过程 在目标 2 中，我们将使用 576 名感染者的定量调查数据来研究粮食不安全的感染者如何利用粮食或现金援助，是否存在意外的积极或消极影响。结果，以及转移对 12 个月时依从性的影响是否因接受者的特征而异，例如依从性的动机和对未来的期望。在研究结束时，我们将有更好的理解。我们还将了解在这种情况下使用的激励措施是否会对艾滋病病毒感染者或其家庭产生额外的意想不到的好处或不利影响。目前正在设计、实施或正在考虑的现金和实物援助计划，以改善艾滋病毒感染者的健康。