Seal Karen H, Kral Alex H, Lorvick Jennifer, McNees Alex, Gee Lauren, Edlin Brian R
Urban Health Study, Department of Family and Community Medicine, University of California San Francisco, San Francisco, CA 94110, USA.
Drug Alcohol Depend. 2003 Aug 20;71(2):127-31. doi: 10.1016/s0376-8716(03)00074-7.
Injection drug users (IDUs) are at high-risk for hepatitis B virus (HBV) and HIV. Due to concerns about non-adherence to multi-dose vaccine regimens however, IDUs are severely under-immunized against HBV and have been excluded from phase III trials of multi-dose candidate HIV vaccines in the United States.
Through a randomized controlled trial, we compared the effectiveness of monetary incentives versus outreach to improve IDUs' adherence to the 3-dose hepatitis B vaccine. In 1998-1999, HBV-susceptible IDUs were recruited from San Francisco streets. Eligible participants received their first dose of vaccine and were randomized to either receive monthly monetary incentives (n=48) or maintain weekly contact with an outreach worker (n=48) during the 6-month vaccine series.
All 3 doses of vaccine were received by 33 (69%) of IDUs in the monetary incentive arm and 11 (23%) in the outreach arm (odds ratio=13.8; 95% confidence interval, 2.9, 128; P<0.0001). In a multivariate model, receiving monetary incentives was independently associated with vaccine completion (AOR=10.3; 95% CI=3.7, 29.0).
Among IDUs, monetary incentives are superior to outreach in achieving adherence to the multi-dose hepatitis B vaccine series. Monetary incentives may be adapted to future multi-dose candidate HIV vaccine trials in IDUs.
注射吸毒者是感染乙型肝炎病毒（HBV）和艾滋病毒（HIV）的高危人群。然而，由于担心对多剂量疫苗接种方案的依从性不佳，注射吸毒者针对HBV的免疫严重不足，并且被排除在美国多剂量HIV候选疫苗的III期试验之外。
通过一项随机对照试验，我们比较了金钱激励与外展服务在提高注射吸毒者对3剂乙型肝炎疫苗依从性方面的效果。1998年至1999年，从旧金山街头招募了对HBV易感的注射吸毒者。符合条件的参与者接种了第一剂疫苗，并被随机分为两组，一组在6个月的疫苗接种期间每月接受金钱激励（n = 48），另一组每周与一名外展工作人员保持联系（n = 48）。
金钱激励组的48名注射吸毒者中有33名（69%）接种了全部3剂疫苗，外展服务组的48名中有11名（23%）（比值比 = 13.8；95%置信区间，2.9，128；P < 0.0001）。在多变量模型中，接受金钱激励与完成疫苗接种独立相关（调整后比值比 = 10.3；95%置信区间 = 3.7，29.0）。
在注射吸毒者中，金钱激励在实现对多剂乙型肝炎疫苗接种的依从性方面优于外展服务。金钱激励可能适用于未来针对注射吸毒者的多剂量HIV候选疫苗试验。
