Brown University School of Public Health, Providence, RI, USA.
Brown University School of Public Health, Providence, RI, USA; University of Cape Town, Cape Town, South Africa.
Soc Sci Med. 2020 Nov;265:113333. doi: 10.1016/j.socscimed.2020.113333. Epub 2020 Aug 29.
High adherence to antiretroviral therapy (ART) is essential for achieving viral suppression and preventing HIV transmission. Yet adherence is suboptimal among adolescents who face unique adherence challenges. Little is known about the role of conditional economic incentives (CEIs) for increasing ART adherence in this population. During 2017-2019, we conducted a mixed-methods discrete choice experiment in Cape Town, South Africa to inform the optimal design of a CEI intervention for ART adherence among youth. In-depth interviews were conducted with n = 35 adolescents (10-19 years old) living with HIV and prescribed ART, to identify attributes of a youth-centered CEI intervention for ART adherence. A discrete choice experiment was subsequently conducted with N = 168 adolescents to elicit preferences for intervention components. A rank-ordered mixed logit model was used for main results; marginal willingness-to-accept (mWTA) was then estimated. Five attributes emerged from the qualitative research as important for a CEI-based intervention for youth ART adherence: (1) incentive amount, (2) incentive format, (3) incentive recipient, (4) delivery mode, and (5) program participants. Youth had a high probability of acceptance of any incentives program (88-100%), yet they did not have a strong preference of a quarterly over a monthly program. From a maximum incentive amount of R1920 (US$115), youth were willing to forgo up to R126 per year (US$9) if the incentive was given in cash (versus fashion vouchers); R274 (US$19.6) if it was open to both previously adherent and non-adherent youth (instead of non-adherent only); and up to R91 (US$6.5) to receive incentives at a clinic setting (instead of electronically). The use of incentives over the short term during the critical age- and developmental-transition, when adolescents begin to take sole responsibility for their medication-taking behaviors, holds great promise for habituating adherence into adulthood.
高抗逆转录病毒疗法 (ART) 依从性对于实现病毒抑制和预防 HIV 传播至关重要。然而，青少年在抗逆转录病毒治疗中存在独特的依从性挑战，其依从性并不理想。对于通过经济激励条件（CEIs）提高这一人群抗逆转录病毒治疗依从性的作用，我们知之甚少。在 2017 年至 2019 年期间，我们在南非开普敦进行了一项混合方法离散选择实验，为针对青年人群抗逆转录病毒治疗依从性的 CEI 干预措施的最佳设计提供信息。我们对 35 名（10-19 岁）感染艾滋病毒并接受抗逆转录病毒治疗的青少年进行了深入访谈，以确定以青少年为中心的 CEI 干预措施对提高抗逆转录病毒治疗依从性的属性。随后，我们对 168 名青少年进行了离散选择实验，以了解他们对干预措施组成部分的偏好。使用排序混合对数模型进行主要结果分析；然后估算了边际意愿支付（mWTA）。从定性研究中得出了五个属性，这些属性对于基于激励条件的青少年抗逆转录病毒治疗依从性干预措施很重要：（1）激励金额，（2）激励形式，（3）激励接受者，（4）交付模式，（5）项目参与者。青少年对接种任何激励计划的接受度都很高（88-100%），但他们对每季度的方案并没有比每月的方案更强烈的偏好。从最高激励金额 1920 兰特（约合 115 美元）开始，青少年愿意每年放弃高达 126 兰特（约合 9 美元），如果激励是以现金（而不是时尚券）的形式发放；如果激励计划对以前依从和不依从的青少年都开放（而不是仅对不依从的青少年开放），他们愿意放弃 274 兰特（约合 19.6 美元）；如果在诊所环境下发放激励（而不是通过电子方式发放），他们愿意放弃高达 91 兰特（约合 6.5 美元）。在青少年开始独自承担服药行为责任的关键年龄和发育过渡期，短期使用激励措施有望使他们习惯成年后的服药依从性。
