The impact of financial incentives on mental health among adults in HIV care in Lake Zone, Tanzania.

IF 3.4 2区 医学 Q3 IMMUNOLOGY AIDS Pub Date : 2024-09-01 Epub Date: 2024-05-30 DOI:10.1097/QAD.0000000000003948
Pooja Chitle, Lila A Sheira, Emmanuel Katabaro, Solis Winters, Prosper F Njau, Amon Sabasaba, Sandra I McCoy
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Abstract

Objective: Depression and anxiety are prevalent among people with HIV (PWH), hindering retention in care. Though economic interventions can improve care engagement and mental health in the general population, this remains understudied among PWH. This study assessed whether financial incentives improve mental health among adult antiretroviral therapy (ART) initiates in Lake Zone, Tanzania.

Design: Two-arm randomized controlled trial.

Methods: From 2021 to 2023, 32 clinics were randomized to offer patients monthly financial incentives (22 500 TSH/US$ 10) for ≤six months (conditional on visit attendance) or standard-of-care (SoC) services. We assessed changes in depression (PHQ-2 scores) and anxiety (GAD-2 scores) symptoms at baseline, six, and 12 months. Difference-in-differences effects were used to estimate changes over time by arm using inverse probability of censoring sample weights (IPCW).

Results: Participants ( n  = 1990) were 57.3% female; median age was 35.0. Baseline prevalences of depression and anxiety symptoms were 66.2% and 60.4%, respectively, and endline prevalences were 7.8% and 7.6% in the intervention and SoC arms, respectively, with no differences by arm. Using IPCW, the differences in the prevalence of depression and anxiety symptoms in the intervention arm compared to the SoC arm were 2.5 percentage points [95% confidence interval (CI): -3.0, 8.0) and 2.3 percentage points (95% CI: -3.2, 7.9) respectively after six months, and 5.5 percentage points (95% CI: -0.20, 10.8) and 3.8 percentage points (95% CI: -1.5, 9.2) respectively after 12 months.

Conclusion: Both study arms experienced substantial reductions in poor mental health, primarily within the first six months of care. Financial incentives provided in this study did not significantly augment these downward trends but may improve engagement in care, indirectly improving mental health.

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经济激励对坦桑尼亚湖区接受 HIV 护理的成年人心理健康的影响:双臂随机对照试验。
目的:抑郁和焦虑在艾滋病病毒感染者(PLHIV)中十分普遍,阻碍了他们继续接受护理。虽然经济干预措施可以提高普通人群的护理参与度和心理健康水平,但在艾滋病病毒感染者中,这方面的研究仍然不足。本研究评估了经济激励措施是否能改善坦桑尼亚湖区成年抗逆转录病毒疗法(ART)启动者的心理健康:设计:双臂随机对照试验:从 2021 年到 2023 年,32 家诊所被随机分配每月为患者提供经济激励(22500 TSH/10 美元),持续时间不超过 6 个月(以就诊率为条件),或提供标准护理(SoC)服务。我们评估了基线、6 个月和 12 个月时抑郁症状(PHQ-2 评分)和焦虑症状(GAD-2 评分)的变化。我们使用反概率删减样本权重(IPCW)来估算各臂随时间的变化情况:参与者(n = 1990)中女性占 57.3%;年龄中位数为 35.0 岁。抑郁症状和焦虑症状的基线患病率分别为 66.2% 和 60.4%,终点患病率分别为 7.8% 和 7.6%,各研究组之间无差异。使用IPCW,6个月后各研究臂的抑郁和焦虑症状患病率分别为2.5个百分点(95% CI:-3.0,8.0)和2.3个百分点(95% CI:-3.2,7.9),12个月后分别为5.5个百分点(95% CI:-0.20,10.8)和3.8个百分点(95% CI:-1.5,9.2):结论:两项研究均显著降低了心理健康不良率,主要是在护理的前 6 个月。本研究中提供的经济激励措施并未显著增强这些下降趋势,但可能会提高护理参与度,从而间接改善心理健康。
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来源期刊
AIDS
AIDS 医学-病毒学
CiteScore
5.90
自引率
5.30%
发文量
478
审稿时长
3 months
期刊介绍: ​​​​​​​​​​​​​​​​​Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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