激励坚持暴露前预防措施以预防艾滋病毒:在墨西哥男性性工作者中开展的随机试点试验。

IF 3.1 3区 医学 Q1 ECONOMICS European Journal of Health Economics Pub Date : 2025-03-01 Epub Date: 2024-07-13 DOI:10.1007/s10198-024-01705-y
Omar Galárraga, Marta Wilson-Barthes, Carlos Chivardi, Nathalie Gras-Allain, Fernando Alarid-Escudero, Monica Gandhi, Kenneth H Mayer, Don Operario
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摘要

对终身健康状况的预防性药物依从性低是导致全球发病率和死亡率的主要原因。我们在墨西哥开展了一项试点随机对照试验,以衡量有条件的经济激励措施能在多大程度上帮助男性性工作者提高对暴露前预防药物(PrEP)的依从性,从而预防艾滋病。我们对 n = 110 名男性性工作者进行了为期 6 个月的跟踪调查。在每个季度的访问中(第 0、3 和 6 个月),所有性工作者都会收到 10 美元的交通费报销、3 个月的 PrEP 免费供应,并完成社会行为调查。主要结果是根据每次就诊时收集的头发中替诺福韦(TFV)药物浓度水平作为坚持用药的客观生物标志物。根据 PrEP 依从性的分级系统,随机接受干预的人将获得奖励:TFV 浓度高(> 0.043 ng/mg)、中(0.011 至 0.042 ng/mg)或低(0.011 至 0.042 ng/mg)的人将获得奖励。
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Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico.

Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence (p = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers (p < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.

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来源期刊
CiteScore
6.10
自引率
2.30%
发文量
131
期刊介绍: The European Journal of Health Economics is a journal of Health Economics and associated disciplines. The growing demand for health economics and the introduction of new guidelines in various European countries were the motivation to generate a highly scientific and at the same time practice oriented journal considering the requirements of various health care systems in Europe. The international scientific board of opinion leaders guarantees high-quality, peer-reviewed publications as well as articles for pragmatic approaches in the field of health economics. We intend to cover all aspects of health economics: • Basics of health economic approaches and methods • Pharmacoeconomics • Health Care Systems • Pricing and Reimbursement Systems • Quality-of-Life-Studies The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfill the above-mentioned requirements. Officially cited as: Eur J Health Econ
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