Optimizing the efficiency and implementation of cash transfers to improve adherenceto antiretroviral therapy

优化现金转移的效率和实施，以提高抗逆转录病毒治疗的依从性

• 批准号: 9349081
• 负责人: Sandra I McCoy
• 金额: $ 61.2万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-14 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9349081
• 关键词: AIDS prevention; Address; Adherence; Adoption; Adult; Adverse effects; Adverse event; Africa South of the Sahara; Anti-Retroviral Agents; Biological; Caring; Clinic; Cluster randomized trial; Continuity of Patient Care; Country; Data; Development; Dose; Effectiveness; Effectiveness of Interventions; Evaluation; Face; Failure; Food; Future; HIV; HIV Infections; HIV diagnosis; Habits; Health; Health behavior; Household; Human immunodeficiency virus test; Income; Individual; Intervention; Interview; K-Series Research Career Programs; Knowledge; Link; Manuals; Measures; Methods; Modeling; Outcome; Pharmaceutical Preparations; Pharmacy facility; Policy Maker; Poverty; Prevention program; Primary Health Care; Process; Program Effectiveness; Public Health; Publishing; Randomized; Research; Resources; Services; Sex Behavior; Social Welfare; Surveys; System; Tanzania; Time; United States National Institutes of Health; Viral; Viral Load result; Visit; antiretroviral therapy; base; behavior change; behavioral economics; cost; design; effectiveness measure; financial incentive; follow-up; food surveillance; implementation science; improved; improved outcome; innovation; mHealth; motivated behavior; poverty reduction; programs; scale up; standard of care; success; therapy adherence; tool; treatment duration

SUMMARY It is increasingly recognized that financial 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 few studies of cash transfers' effect on adherence and/or retention among people living with HIV infection (PLHIV) in Sub-Saharan Africa, which has the greatest burden of HIV and faces persistent challenges with poverty and food insecurity. The proposed research will advance global knowledge about cash transfers for PLHIV by building on preliminary data from a study we conducted in Shinyanga, Tanzania. The study found that short-term cash transfers can improve ART adherence and retention in care among food insecure PLHIV. We will now leverage our established research program to improve and rigorously evaluate our cash transfer intervention, which is intended to offer short-term support during the vulnerable period of treatment initiation, support the development of good adherence habits, and protect individual and household welfare. In our 5-year study, we will first determine in a randomized study with 519 PLHIV whether a smaller cash transfer can improve retention in care and viral suppression at 12 months (Aim 1). After selecting the optimal cash transfer size, we will implement a cluster-randomized trial in 32 facilities with 1,984 PLHIV to evaluate the cash transfer intervention for its effectiveness on 12-month viral suppression (Aim 2). We will also conduct a mixed-methods process evaluation to understand facility-level implementation successes and challenges (Aim 3). Throughout our project, cash transfers will be delivered through an innovative and efficient mHealth system that overcomes the resource-intensive process of manually distributing cash transfers. At the conclusion of the project, we will have determined an efficient and scalable model of the intervention and its effectiveness, consistent with an implementation science approach to close the gap between evidence and practice in real-world contexts. This timely information will be widely applicable to the spectrum of cash transfer programs currently being designed, implemented, or under consideration to improve the health of PLHIV. Furthermore, this research will help policy makers understand whether cash transfers should be incorporated into ongoing `treatment as prevention' (TasP) programs.

概括 人们越来越认识到经济激励可以激励行为改变并改善结果 沿着艾滋病毒护理连续体。在适当的情况下，财政激励措施可以增加对 艾滋病毒检测，改变短期性行为，加强艾滋病毒诊断后护理的联系，并促进 抗逆转录病毒治疗（ART）依从性。然而，关于现金转移对依从性影响的研究很少。 撒哈拉以南非洲地区艾滋病毒感染者 (PLHIV) 的留存率和/或留存率最高， 艾滋病毒负担，并面临贫困和粮食不安全的持续挑战。 拟议的研究将通过建立在 初步数据来自我们在坦桑尼亚辛扬加进行的一项研究。研究发现，短期现金 转移可以提高粮食不安全的艾滋病病毒感染者的抗逆转录病毒疗法的依从性和护理保留率。我们现在将利用 我们制定的研究计划旨在改进和严格评估我们的现金转移干预措施，即 旨在在治疗开始的脆弱时期提供短期支持，支持 养成良好的遵守习惯，保障个人和家庭福利。在我们5年的研究中，我们 将首先在一项针对 519 名艾滋病毒感染者的随机研究中确定较小的现金转移是否可以改善 12 个月时保留护理和病毒抑制（目标 1）。选择最佳现金转移规模后，我们 将在 32 个设施中对 1,984 名艾滋病毒感染者进行整群随机试验，以评估现金转移 干预措施对 12 个月病毒抑制的有效性（目标 2）。我们还将进行混合方法 过程评估，以了解设施级实施的成功和挑战（目标 3）。自始至终 在我们的项目中，现金转移将通过创新且高效的移动医疗系统进行，该系统克服了 手动分配现金转移的资源密集型过程。 在项目结束时，我们将确定一个有效且可扩展的干预模型 其有效性，符合缩小证据与证据之间差距的实施科学方法 在现实世界中进行实践。这些及时的信息将广泛适用于现金转移领域 目前正在设计、实施或正在考虑的旨在改善艾滋病毒感染者健康的计划。 此外，这项研究将帮助政策制定者了解是否应将现金转移纳入 纳入正在进行的“治疗即预防”（TasP）计划。