Behavioral Economic Incentives to Support HIV Care: Results From a Randomized Controlled Trial in Uganda.

IF 2.9 3区医学 Q3 IMMUNOLOGY JAIDS Journal of Acquired Immune Deficiency Syndromes Pub Date : 2024-07-01 DOI:10.1097/QAI.0000000000003420

Sebastian Linnemayr, Zachary Wagner, Uzaib Y Saya, Chad Stecher, Lillian Lunkuse, Peter Wabukala, Mary Odiit, Barbara Mukasa

{"title":"Behavioral Economic Incentives to Support HIV Care: Results From a Randomized Controlled Trial in Uganda.","authors":"Sebastian Linnemayr, Zachary Wagner, Uzaib Y Saya, Chad Stecher, Lillian Lunkuse, Peter Wabukala, Mary Odiit, Barbara Mukasa","doi":"10.1097/QAI.0000000000003420","DOIUrl":null,"url":null,"abstract":"Background: This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with 1 approach being low cost.Setting: Three hundred twenty-nine adults at Mildmay Hospital in Kampala, Uganda, on ART for at least 2 years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown.Methods: We randomized participants into 1 of 3 (1:1:1) groups: usual care (\"control\" group; n = 109) or 1 of 2 intervention groups where eligibility for nonmonetary prizes was based on showing at least 90% electronically measured ART adherence (\"adherence-linked\" group, n = 111) or keeping clinic appointments as scheduled (\"clinic-linked\"; n = 109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777 .Results: Neither incentive arm increased adherence compared with the control; we estimate a 3.9 percentage point increase in \"adherence-linked\" arm [95% confidence interval (CI): -0.70 to 8.60 ( P = 0.10)] and 0.024 in the \"clinic-linked\" arm [95% CI: -0.02 to 0.07 ( P = 0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI: 0.01, 0.15; P = 0.04, \"adherence-linked\") and 5.60 percentage points (95% CI: -0.01, 0.12; P = 0.10, \"clinic-linked\"). We find no effects on clinic attendance or viral suppression.Conclusions: Incentives did not improve viral suppression or ART adherence overall but worked for the prespecified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.","PeriodicalId":14588,"journal":{"name":"JAIDS Journal of Acquired Immune Deficiency Syndromes","volume":" ","pages":"250-258"},"PeriodicalIF":2.9000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11192614/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAIDS Journal of Acquired Immune Deficiency Syndromes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/QAI.0000000000003420","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"IMMUNOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with 1 approach being low cost.

Setting: Three hundred twenty-nine adults at Mildmay Hospital in Kampala, Uganda, on ART for at least 2 years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown.

Methods: We randomized participants into 1 of 3 (1:1:1) groups: usual care ("control" group; n = 109) or 1 of 2 intervention groups where eligibility for nonmonetary prizes was based on showing at least 90% electronically measured ART adherence ("adherence-linked" group, n = 111) or keeping clinic appointments as scheduled ("clinic-linked"; n = 109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777 .

Results: Neither incentive arm increased adherence compared with the control; we estimate a 3.9 percentage point increase in "adherence-linked" arm [95% confidence interval (CI): -0.70 to 8.60 ( P = 0.10)] and 0.024 in the "clinic-linked" arm [95% CI: -0.02 to 0.07 ( P = 0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI: 0.01, 0.15; P = 0.04, "adherence-linked") and 5.60 percentage points (95% CI: -0.01, 0.12; P = 0.10, "clinic-linked"). We find no effects on clinic attendance or viral suppression.

Conclusions: Incentives did not improve viral suppression or ART adherence overall but worked for the prespecified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

支持艾滋病护理的行为经济激励措施：乌干达随机对照试验的结果。

背景：这项研究测试了通过行为经济学激励措施提高抗逆转录病毒治疗依从性的方法：本研究测试了行为经济学激励措施，以改善抗逆转录病毒治疗（ART）的依从性，其中一种方法成本较低：乌干达坎帕拉米尔德梅医院的 329 名成年人接受了为期约 15 个月的干预，这些成年人至少接受了两年的抗逆转录病毒疗法，并且在坚持治疗方面存在问题，直到研究因全国范围内的 COVID-19 封锁而中断：我们将参与者随机分为三组（1:1:1）：常规护理组（"对照 "组，人数=109）或两组干预组，其中一组干预组的非货币奖品资格基于以下条件：电子测量的抗逆转录病毒疗法依从性至少达到 90%（"依从性相关 "组，人数=111）；或按时预约门诊（"门诊相关 "组，人数=109）。12 个月后，如果参与者的依从性或病毒抑制率一直很高，则可赢得更丰厚的奖品。主要结果为平均依从性和病毒抑制率。采用线性回归进行意向治疗分析。该试验已在 ClinicalTrials.gov 登记，编号为 NCT03494777：与对照组相比，两个激励组都没有提高依从性；我们估计 "与依从性挂钩 "组提高了3.9个百分点[95% CI -0.70 至 8.60 (p=0.10)]，而 "与临床挂钩 "组提高了0.024个百分点[95% CI -0.02 至 0.07 (p=0.28)]。对于预设的初始依从性较低的亚组，激励措施使依从性提高了 7.60 个百分点（95% CI 0.01，0.15；p=0.04，"与依从性相关"）和 5.60 个百分点（95% CI -0.01，0.12；p=0.10，"与诊所相关"）。我们没有发现激励措施对就诊率或病毒抑制率有任何影响：总体而言，激励措施并未改善病毒抑制率或抗病毒疗法的依从性，但对初始依从性较低的预设亚组有效。如果能更有效地识别需要坚持治疗支持的人群，就能更有针对性地采取该激励措施和其他激励措施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

JAIDS Journal of Acquired Immune Deficiency Syndromes 医学-传染病学

CiteScore

5.80

自引率

5.60%

发文量

490

审稿时长

3-6 weeks

期刊介绍： JAIDS: Journal of Acquired Immune Deficiency Syndromes seeks to end the HIV epidemic by presenting important new science across all disciplines that advance our understanding of the biology, treatment and prevention of HIV infection worldwide. JAIDS: Journal of Acquired Immune Deficiency Syndromes is the trusted, interdisciplinary resource for HIV- and AIDS-related information with a strong focus on basic and translational science, clinical science, and epidemiology and prevention. Co-edited by the foremost leaders in clinical virology, molecular biology, and epidemiology, JAIDS publishes vital information on the advances in diagnosis and treatment of HIV infections, as well as the latest research in the development of therapeutics and vaccine approaches. This ground-breaking journal brings together rigorously peer-reviewed articles, reviews of current research, results of clinical trials, and epidemiologic reports from around the world.