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: 10654707
• 负责人: Sandra I McCoy
• 金额: $ 62.79万
• 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/10654707
• 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; Food; Gender; Goals; Government; HIV; HIV Infections; Health; Home; Home visitation; Incentives; Individual; Intervention; Interview; Investments; Knowledge; Learning; Longterm Follow-up; Machine Learning; Medical Records; Methods; Motivation; NIH Office of AIDS Research; Outcome; Participant; Persons; Pilot Projects; Populations at Risk; Poverty; Prevention; Prevention program; Provider; Randomized; Recommendation; Reporting; Research; Research Priority; Risk; Safety; Services; Southern Africa; Surveys; Tanzania; Testing; Time; Universities; Viral; Viral Load result; Visit; Vulnerable Populations; antiretroviral therapy; behavior change; behavioral economics; combat; comparison group; design; effectiveness evaluation; effectiveness measure; effectiveness/implementation study; epidemic response; 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，如果不改进艾滋病毒流行控制的全球目标就无法实现 只有 58% 的艾滋病毒感染者坚持接受艾滋病毒护理并坚持抗逆转录病毒治疗 (ART)。 东部和南部非洲的艾滋病毒携带者（艾滋病毒携带者）受到病毒抑制，并向这些人提供依从性咨询 病毒载量升高仅在 40-50% 的情况下导致病毒抑制 经济激励首先用于。 减贫，已被证明可以激励行为改变并提高对艾滋病毒相关问题的参与 然而，关于基于激励的计划对人们的有效性的数据却很少。 那些已经脱离艾滋病毒护理的人以及积极利用激励措施帮助艾滋病毒感染者 这一研究差距限制了我们对经济激励计划是否值得的理解。 投资支持终身护理，这对于“治疗即艾滋病预防”（TasP）的成功至关重要。 拟议的研究将增进全球对财政激励措施有效性的认识 我们将利用在坦桑尼亚进行的试点研究的数据来加强艾滋病毒护理的连续性。 该研究发现，向处于护理之外的艾滋病病毒感染者提供一次性经济激励的干预措施是可行的， 可以接受，并且在激励重新参与艾滋病毒护理方面初步有效。 研究计划和行为经济学专业知识，我们设计了一个为期 5 年的混合方法混合 有效性实施研究，评估财务激励干预并描述其成功 的实施，最终目标是缩小实现联合国艾滋病规划署“95-95-95”目标的差距。 将首先评估一次性经济激励措施是否可以改善重新参与护理和持久的病毒抑制 盖塔和卡盖拉地区 640 名已脱离护理的艾滋病毒感染者在 12 个月时（目标 1）。 然后将衡量向 692 名处于护理中的艾滋病病毒感染者提供的短期经济激励措施的有效性。 失去随访或依从性差的风险，结果是 12 个月时持久抑制病毒（目标 2) 混合方法研究将描述实施的成功和挑战并总结经验教训。 学会告知采用针对弱势艾滋病毒感染者的激励计划（目标 3）。 加州大学伯克利分校，繁荣国家的健康，Rasello，管理与发展 卫生部和坦桑尼亚卫生、社区发展、性别、老年人和儿童部。 在项目结束时，我们将严格评估激励策略并了解 与美国国立卫生研究院办公室一致，它是否可以缓解脱离艾滋病毒护理所带来的持续挑战 艾滋病研究重点是关于保留护理和坚持抗逆转录病毒治疗的研究实施。 信息与正在实施或正在实施的一系列基于激励的计划高度相关 考虑改善艾滋病毒感染者的健康并优化联合国艾滋病规划署快速通道国家的 TasP 项目。 1