Department of Global Health and Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, USA.
Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
J Int AIDS Soc. 2020 Jun;23 Suppl 2(Suppl 2):e25519. doi: 10.1002/jia2.25519.
Among people living with HIV in South Africa, viral suppression is lower among men than women. The study aim was to test the impact of lottery incentives, which reward positive health choice (e.g. antiretroviral therapy (ART) linkage) with a chance to win a prize, on strengthening the HIV care continuum including ART initiation and viral suppression for men.
We conducted a randomized, prospective trial of lottery incentives in the context of HIV testing and linkage to ART in rural KwaZulu-Natal, South Africa. Men living with HIV were randomly allocated to: lottery incentives and motivational text messages or motivational text messages only. Lottery prize eligibility was conditional on clinic registration, ART initiation, or viral suppression by one, three and six months respectively. After completing each continuum step, participants in the lottery group were notified whether they had won and were encouraged to continue in care. Lottery prizes were either a mobile phone, data or a gift card (valued at R1000/$100). Kaplan-Meier curves were plotted to determine time to ART initiation by study group. The primary outcome was viral suppression at six months.
Between November 2017 and December 2018, we tested 740 men for HIV and enrolled 131 HIV-positive men who reported not being on ART. At baseline, 100 (76%) participants were 30 years and older, 95 (73%) were unemployed and the median CD4 count was 472 cells/μL. At study exit, 84% (110/131) of participants had visited a clinic and 62% (81/131) were virally suppressed. Compared to motivational text messages, lottery incentives decreased the median time to ART initiation from 126 to 66 days (p = 0.0043, age-adjusted Cox regression) among all participants, and, from 134 days to 20 days (p = 0.0077) among participants who were not virally suppressed at baseline. Lottery incentives had an inconclusive effect on clinic registration (RR = 1.21, 95% CI: 0.83 to 1.76) and on viral suppression at six months (RR = 1.13, 95% CI: 0.73 to 1.75) compared to motivational text messages.
Conditional lottery incentives shortened the time to ART initiation among South African men. Behavioural economics strategies strengthen linkage to ART, but the study power was limited to see an impact on viral suppression.
NCT03808194.
在南非的 HIV 感染者中，男性的病毒抑制率低于女性。本研究旨在测试彩票激励措施的影响，该措施通过奖励积极的健康选择（例如抗逆转录病毒治疗（ART）衔接）来获得中奖机会，从而加强包括 ART 启动和病毒抑制在内的 HIV 护理连续体，以男性为对象。
我们在南非夸祖鲁-纳塔尔省农村地区进行了一项关于 HIV 检测和与 ART 衔接的彩票激励的随机、前瞻性试验。HIV 阳性男性被随机分配到以下两组：彩票激励和激励性短信或仅激励性短信。彩票中奖资格取决于诊所登记、ART 启动或分别在一个、三个月和六个月时达到病毒抑制。在完成每个连续体步骤后，彩票组的参与者将被告知他们是否中奖，并鼓励他们继续接受护理。彩票奖品可以是手机、数据或价值 1000 兰特/100 美元的礼品卡。绘制 Kaplan-Meier 曲线以确定按研究组计算的 ART 启动时间。主要结局是六个月时的病毒抑制。
2017 年 11 月至 2018 年 12 月，我们对 740 名男性进行了 HIV 检测，并招募了 131 名未接受 ART 治疗的 HIV 阳性男性。基线时，100 名（76%）参与者年龄在 30 岁及以上，95 名（73%）失业，中位 CD4 计数为 472 个/μL。研究结束时，84%（110/131）的参与者曾就诊过诊所，62%（81/131）的病毒得到抑制。与激励性短信相比，彩票激励使所有参与者从 126 天缩短到 66 天（p=0.0043，年龄调整后的 Cox 回归），使基线时未达到病毒抑制的参与者从 134 天缩短到 20 天（p=0.0077）。彩票激励对诊所登记（RR=1.21，95%CI：0.83 至 1.76）和六个月时的病毒抑制（RR=1.13，95%CI：0.73 至 1.75）的影响尚无定论，与激励性短信相比。
有条件的彩票激励措施缩短了南非男性接受抗逆转录病毒治疗的时间。行为经济学策略加强了与 ART 的衔接，但研究的力量有限，无法观察到对病毒抑制的影响。
NCT03808194。
