激励措施对同时使用可卡因或阿片类药物的 HIV 感染者病毒抑制的影响。
Effects of incentives on viral suppression in people living with HIV who use cocaine or opiates.
机构信息
Department of Psychiatry and Behavioral Sciences, Center for Learning and Health, Johns Hopkins University School of Medicine, 5200 Eastern Avenue Suite 350 East, Baltimore, MD, 21224, USA.
Department of Medicine, Comprehensive Care Practice, Johns Hopkins Bayview Medical Center, 5200 Eastern Ave # W2, Baltimore, MD 21224, USA.
出版信息
Drug Alcohol Depend. 2020 Jul 1;212:108000. doi: 10.1016/j.drugalcdep.2020.108000. Epub 2020 Apr 25.
BACKGROUND
Antiretroviral therapy (ART) adherence is essential to maintenance of undetectable viral loads among people living with HIV, which improves health and reduces HIV transmission. Despite these benefits, some people living with HIV do not maintain the level of adherence required to sustain an undetectable viral load. This problem is particularly common among people who use drugs.
OBJECTIVE
To determine effects of incentivizing viral suppression in people living with HIV who used cocaine or opiates.
METHODS
In this secondary analysis of data collected during a randomized controlled trial, participants (N=102) with detectable HIV viral loads (>200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with reduced or undetectable (<200 copies/mL) viral loads. All participants completed assessments every three months. Results collected during the first year were compared based on group assignment and drug use.
RESULTS
Among participants who used cocaine or opiates, Incentive participants (n = 27) provided more (OR:4.0, CI:1.6-10.3, p = .004) blood samples with an undetectable viral load (69 %) than Usual Care participants (n = 25; 41 %). Among participants who did not use cocaine or opiates, Incentive participants (n = 25) provided more (OR:4.1, CI:1.5-10.7, p = .005) blood samples with an undetectable viral load (78 %) than Usual Care participants (n = 25; 36 %). Effects of incentives did not differ by drug use (OR:1.0, CI:0.3-4.0, p = .992).
CONCLUSIONS
Incentivizing viral suppression can promote undetectable viral loads in people living with HIV who use cocaine or opiates.
背景
抗逆转录病毒疗法（ART）的依从性对于维持 HIV 感染者的病毒载量不可检测至关重要，这可以改善健康状况并降低 HIV 传播。尽管有这些益处，但仍有一些 HIV 感染者无法维持维持不可检测的病毒载量所需的依从水平。这个问题在使用毒品的人群中尤为普遍。
目的
确定激励 HIV 感染者（使用可卡因或阿片类药物）抑制病毒的效果。
方法
在一项随机对照试验期间收集的数据的二次分析中，研究对象（N=102）具有可检测的 HIV 病毒载量（>200 拷贝/ml），被随机分配到常规护理或激励组。常规护理组参与者不因病毒抑制而获得奖励。激励组参与者因提供载量降低或不可检测（<200 拷贝/ml）的血液样本而获得最高每天 10 美元的奖励。所有参与者每三个月完成一次评估。根据分组和药物使用情况比较第一年收集的结果。
结果
在使用可卡因或阿片类药物的参与者中，激励组（n=27）提供了更多（OR：4.0，CI：1.6-10.3，p=.004）不可检测病毒载量（69%）的血液样本，而常规护理组（n=25；41%）。在未使用可卡因或阿片类药物的参与者中，激励组（n=25）提供了更多（OR：4.1，CI：1.5-10.7，p=.005）不可检测病毒载量（78%）的血液样本，而常规护理组（n=25；36%）。激励的效果不因药物使用而不同（OR：1.0，CI：0.3-4.0，p=.992）。
结论
激励抑制病毒可以促进使用可卡因或阿片类药物的 HIV 感染者实现不可检测的病毒载量。
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