Department of Medicine, Connecticut VA Healthcare System, West Haven, CT, USA.
AIDS Behav. 2013 Sep;17(7):2293-300. doi: 10.1007/s10461-013-0416-1.
The role of financial incentives in HIV care is not well studied. We conducted a single-site study of monetary incentives for viral load suppression, using each patient as his own control. The incentive size ($100/quarter) was designed to be cost-neutral, offsetting estimated downstream costs averted through reduced HIV transmission. Feasibility outcomes were clinic workflow, patient acceptability, and patient comprehension. Although the study was not powered for effectiveness, we also analyzed viral load suppression. Of 80 eligible patients, 77 consented, and 69 had 12 month follow-up. Feasibility outcomes showed minimal impact on patient workflow, near-unanimous patient acceptability, and satisfactory patient comprehension. Among individuals with detectable viral loads pre-intervention, the proportion of undetectable viral load tests increased from 57 to 69 % before versus after the intervention. It is feasible to use financial incentives to reward ART adherence, and to specify the incentive by requiring cost-neutrality and targeting biological outcomes.
财务激励在艾滋病毒护理中的作用尚未得到充分研究。我们进行了一项关于病毒载量抑制的金钱激励的单站点研究，每个患者都是自己的对照。激励金额（每季度 100 美元）的设计是成本中性的，通过减少艾滋病毒传播来抵消估计的下游成本。可行性结果是临床工作流程、患者可接受性和患者理解。尽管该研究没有针对效果进行设计，但我们也分析了病毒载量抑制。在 80 名符合条件的患者中，77 名同意参加，69 名患者有 12 个月的随访。可行性结果表明，对患者工作流程的影响很小，患者几乎一致接受，患者理解程度也令人满意。在干预前可检测到病毒载量的个体中，未检测到病毒载量检测的比例从干预前的 57%增加到 69%。使用财务激励来奖励抗逆转录病毒治疗依从性是可行的，并通过要求成本中性和针对生物学结果来具体说明激励措施。
