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（由适用提供）：越来越多地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体的结果。在适当的情况下，经济激励措施可以增加对艾滋病毒测试的需求，改变短期性行为，加强与艾滋病毒诊断后的护理联系，并促进抗逆转录病毒疗法（ART）遵守。但是，我们对激励措施改善健康以及它们是否具有意想不到的后果和利益的途径的理解存在很大的差距。这些知识差距排除了为什么激励措施在某些程序中起作用而不是在其他程序中起作用的确定性解释，并限制了我们对将来包含哪些组件包含的组件的理解。了解激励措施改变行为并为其工作最佳的机制对于指导各种环境中的基于激励计划的规模，包括针对艾滋病毒感染的人（PLHIV）（PLHIV）的人。我们有机会通过利用我们正在进行的短期食品和现金转移研究来解决这一知识差距，用于坦桑尼亚Shinyanga的粮食不安全PLHIV。这项研究包括随机接受6个月的食物或现金转移的食品不安全的PLHIV，以临床访问的到来，旨在减少对艺术依从性和保留护理的障碍。此处提出的混合方法研究探讨了父母研究中未解决的问题，并将使用两种完整的方法来探索激励措施运作的途径。在AIM 1中，我们将进行一项定性研究，包括32次对PLHIV的深入访谈，以探讨个人，家庭和结构性因素对如何利用食物或现金援助的决策过程的影响以及这如何影响逆境。在AIM 2中，我们将使用来自576 PLHIV的定量调查数据来检查食品不安全的PLHIV如何利用食物或现金援助，无论是意外的还是负面结果，以及12个月（12个月的转移对依从性的影响）是否取决于收件人的特征，例如激励人的特征，例如在未来和未来的预期。在研究结束时，我们将更好地理解激励措施可以提高对艺术和保留护理的遵守的机制。我们还将知道这种环境中使用的激励措施是否在PLHIV或其家庭中还具有其他意想不到的好处或不利影响。此及时信息可能广泛适用于目前正在设计，实施或正在考虑的现金和实物援助计划，以改善PLHIV的健康状况。