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

针对艾滋病毒治疗依从性、保留性和重新参与护理的短期激励计划的有效性

• 批准号: 9560641
• 负责人: Sandra I McCoy
• 金额: $ 16.14万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-05-15 至 2020-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9560641
• 关键词: AIDS prevention; AIDS/HIV problem; Adherence; Adult; Adverse effects; Africa South of the Sahara; Appointment; Authorization documentation; Back; Caring; Cessation of life; Clinic; Clinic Visits; Clinical; Consent; Continuity of Patient Care; Counseling; Country; Data; Democratic Republic of the Congo; Economics; Effectiveness; Effectiveness of Interventions; Enrollment; Epidemic; Failure; Food; Future; Goals; HIV; HIV Infections; HIV diagnosis; Health; Home environment; Home visitation; Household; Human immunodeficiency virus test; Incentives; Individual; Intervention; Interview; Investments; K-Series Research Career Programs; Knowledge; Link; Measures; Medical; Medical Records; Outcome; Participant; Patient Transfer; Patients; Pharmaceutical Preparations; Pharmacy facility; Pilot Projects; Policy Maker; Poverty; Prevalence; Prevention program; Public Health; Randomized; Records; Research; Services; Sex Behavior; Tanzania; Time; Transportation; Uganda; United States National Institutes of Health; Update; Viral; Visit; Vital Status; antiretroviral therapy; base; behavior change; care providers; design; follow-up; improved; improved outcome; incentive program; incentive strategies; incentive-based intervention; mortality; motivated behavior; opportunity cost; patient subsets; programs; standard of care; systematic review; therapy adherence; tool; treatment adherence; willingness

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

概括 人们越来越认识到现金和实物激励措施可以激励行为改变并改善 沿艾滋病毒护理连续体的结果。在适当的情况下，激励措施可以增加需求 为了进行艾滋病毒测试，改变短期性行为，提高艾滋病毒诊断后与护理的联系并促进 短期抗逆转录病毒疗法（ART）依从性。但是，长期随访数据很少 关于针对艾滋病毒感染患者（PLHIV）的激励计划。这个研究差距限制了我们的 了解这些方法是否值得投资，尤其是在广义艾滋病毒中 撒哈拉以南非洲的流行病。 拟议的研究将提高有关奖励艺术的长期有效性的全球知识 遵守和保留护理，及其在护理中重新参与的潜在有效性。我们将基础 我们在坦桑尼亚Shinyanga进行的一项研究的初步数据发现，短期现金和食物 援助改善了6个月和12个月后的粮食不安全PLHIV的艺术依从性和保留率 随访。现在，我们将利用我们既定的研究计划来确定长期有效性 这些激励策略。在我们的两年研究中，我们将首先确定24个月的依从性和保留率 使用医学和药房记录的结果为781 PLHIV，他们在我们以前的结束时还活着 研究，在随访12个月后得出结论（AIM 1）。然后，利用现有的家庭计划 基于护理，我们将确定该子集中无证转移和死亡的患病率 发现患者在诊所记录中失去了随访或转移。我们将从家庭访问中使用这些数据 调整干预措施对艾滋病毒护理和死亡率保留的有效性的估计（AIM 2）。在 发现PLHIV已与护理脱离，我们将对一次性现金激励进行试点研究 鼓励PLHIV谨慎地重新参与，目的是减轻运输和 机会成本（目标3）。 该项目结束时，我们将知道现金和食品激励措施的长期有效性 依从性和保留率，以及是否也可以用于重新链接PLHIV来照顾数据，数据高度相关 在快速国家 /地区“处理所有”计划。此及时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进 PLHIV的健康。此外，这项研究将帮助制定者了解基于激励的 程序应纳入正在进行的“预防治疗”（TASP）计划中。 1