Innovative incentive strategies for sustainable HIV testing and linkage to care

可持续艾滋病毒检测和与护理联系的创新激励策略

基本信息

批准号：
8992269
负责人：
Gabriel Chamie
金额：
$ 68.23万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-08 至 2020-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8992269
关键词：
AIDS prevention Absenteeism at work Acquired Immunodeficiency Syndrome Adult Affect Africa South of the Sahara Aftercare Attention Attitude Behavior Caring Childbirth Cluster randomized trial Communities Country Decision Making Diagnosis Economics Effectiveness Ensure Future HIV HIV Infections HIV Seropositivity HIV diagnosis Health Health Care Seeking Behavior Health behavior Healthcare Human immunodeficiency virus test Incentives Individual Infection International Intervention Interview Investments Left Link Low income Motivation Ownership Pathway interactions Pattern Perception Persons Prevention Prevention strategy Prize Probability Psychology Qualitative Research Randomized Randomized Controlled Trials Research Research Infrastructure Research Methodology Resources Rewards Risk Rural Sampling Scientific Advances and Accomplishments Surveys Testing Time Uganda Visit Weight Woman arm base behavioral economics care seeking comparative effectiveness cost cost effective cost effectiveness economic incentive effective intervention falls high risk high risk behavior high risk men improved innovation insight male men novel older men preference primary outcome psychosocial public health relevance secondary outcome success theories uptake

AIDS prevention Absenteeism at work Acquired Immunodeficiency Syndrome Adult Affect Africa South of the Sahara Aftercare Attention Attitude Behavior Caring Childbirth Cluster randomized trial Communities Country Decision Making Diagnosis Economics Effectiveness Ensure Future HIV HIV Infections HIV Seropositivity HIV diagnosis Health Health Care Seeking Behavior Health behavior Healthcare Human immunodeficiency virus test Incentives Individual Infection International Intervention Interview Investments Left Link Low income Motivation Ownership Pathway interactions Pattern Perception Persons Prevention Prevention strategy Prize Probability Psychology Qualitative Research Randomized Randomized Controlled Trials Research Research Infrastructure Research Methodology Resources Rewards Risk Rural Sampling Scientific Advances and Accomplishments Surveys Testing Time Uganda Visit Weight Woman arm base behavioral economics care seeking comparative effectiveness cost cost effective cost effectiveness economic incentive effective intervention falls high risk high risk behavior high risk men improved innovation insight male men novel older men preference primary outcome psychosocial public health relevance secondary outcome success theories uptake

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项目摘要

DESCRIPTION (provided by applicant): Significant resources have been invested in HIV testing to date, yet over half of adults globally remain unaware of their HIV status. Men in particular fall well below international HIV testing targets and those at highest risk of HIV infection are often the least likely to participate in community-based mobile HIV testing efforts. HIV- infected men also link to care at lower rates than women. Both the male testing and linkage to care "gaps" pose a challenge for the implementation of combination HIV prevention strategies, including treatment as prevention (TasP). Identifying interventions to increase HIV testing among men - particularly those engaged in high-risk behaviors - is thus an HIV prevention priority in sub-Saharan Africa. Although economic incentives - the offer of economic rewards that are conditional on undertaking a certain action - have been found to be effective in modifying health behaviors in low-income countries, existing approaches to incentives have failed to incorporate prominent insights from behavioral economics, leaving room for "smarter" incentive-based interventions that can be more effective and less expensive in increasing uptake of HIV testing and linkage to care. The long-term sustainability and cost-effectiveness of such interventions have also yet to be clearly established. This study will implement and evaluate novel incentive-based interventions to increase HIV testing among high-risk men and link HIV-infected adults to treatment. Aim 1 will build on insights from behavioral economics theories and studies, and test the premises that (1) incentives in the form of lotteries, with smal probabilities of winning high-value prizes as a result of HIV testing, may be more powerful than small, fixed incentives for HIV testing; and (2) individuals display "loss aversion (a reluctance t lose something they already own) and therefore are less motivated by the possibility of gaining something from HIV testing (i.e. a standard fixed incentive) than the possibility of losing something from not testing. The lottery-based incentives are likely to be most appealing to individuals with risk-seeking preferences, thereby ensuring that HIV testing is promoted in a targeted and inexpensive manner. Lottery and loss aversion-based incentives will be compared to fixed incentives, in a three-arm, randomized controlled trial. Aim 2 will draw upon the existence of loss aversion in individuals' decision-making patterns to examine whether men who test HIV-positive are more likely to link to care if the incentive offered to them features a saliet, immediate benefit to early linkage. Aim 3 will assess the sustainability and cost-effectiveness of novel economic incentives to increase testing by analyzing the effect of one-time incentives on subsequent HIV testing when incentives are no longer offered. The study will advance the scientific understanding of how and why incentives influence decision-making while also identifying low-cost, sustainable ways to increase demand for HIV testing among high-risk individuals, improve linkage to care, and ultimately facilitate the implementation of combination HIV prevention strategies.

描述（由适用提供）：迄今为止，已经在HIV测试中投资了大量资源，但全球一半以上的成年人仍未意识到其HIV状况。尤其是男性远低于国际艾滋病毒测试目标，而艾滋病毒感染风险最高的男性通常是参与基于社区的移动艾滋病毒测试工作的最不可能的。感染艾滋病毒的男性还以低于女性的速度与护理相关。男性测试和关注“差距”的联系都对实施HIV预防策略的实施构成了挑战，包括预防治疗（TASP）。因此，确定增加男性的艾滋病毒测试的干预措施，尤其是从事高风险行为的人 - 因此，撒哈拉以南非洲的艾滋病毒预防优先级。尽管经济激励措施 - 有条件采取一定行动的经济奖励的提供 - 已被发现有效地修改低收入国家的健康行为，但现有的激励措施未能从行为经济学中获得突出的洞察力，为“智能”激励措施的空间纳入了基于“智能”的基于“智能”的干预措施，该干预措施可以有效地有效地在HIV上进行更便宜和更便宜的HIV和更便宜。此类干预措施的长期可持续性和成本效益尚未明确建立。这项研究将实施和评估基于新型激励的干预措施，以增加高危男性的HIV检测，并将感染HIV的成年人与治疗联系起来。 AIM 1将基于行为经济学理论和研究的见解，并测试以下前提：（1）以彩票形式的激励措施，由于HIV测试而赢得高价值隐私的可能性，可能比对HIV测试的小型，固定的激励措施更强大；（2）个人表现出“遭受损失（不情愿的失去他们已经拥有的东西）），因此，与不从艾滋病毒测试（即标准的固定激励措施）中获得某些东西相比，与不进行彩票基于彩票的激励措施的可能性相比，可能会促进群体的偏好，并促进afterive andiv andiv andiv andiv andiv andiv诱因的可能性最大。将基于厌恶的激励措施与固定激励措施进行比较，在三臂的随机对照试验中，AIM 2将利用个人决策模式中的损失厌恶，以检查HIV阳性的男性是否更有可能与他们的动力相关，以确保其能力的效果，并将其效果增长。当不再提供激励措施时，一次性激励措施是随后的艾滋病毒测试。该研究将进一步了解激励措施如何以及为什么影响决策的科学理解，同时还确定了低成本，可持续的方法来增加高风险个体之间对艾滋病毒测试的需求，改善与护理的联系，并最终支持预防艾滋病毒的组合预防策略。