Galárraga Omar, Enimil Anthony, Bosomtwe Dennis, Cao Wangnan, Barker David H
Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, United States.
Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Vulnerable Child Youth Stud. 2020;15(3):257-268. doi: 10.1080/17450128.2019.1709678. Epub 2019 Dec 27.
Poor adherence to antiretroviral therapy (ART) has significant consequences for adolescents. Conditional economic incentives (CEI) is an approach that may help address this challenge. This study evaluated the safety and preliminary efficacy of a group-based CEI program for ART adherence improvement among a sample of adolescents living in Ghana. A total of 35 adolescents (mean age: 14.7 years) on ART, though still with detectable viral load, were recruited from an HIV clinic and divided into 5 balanced groups to participate in peer-led group-based CEI activities during routine clinic visits. Four assessments were conducted across four visits at baseline and 3-, 6-, and 9-month follow-up, respectively. Main outcomes were ART adherence and viral load. Linear mixed models and thematic analysis were used for data analyses. The majority (91.4%) of the participants attended all four intervention activities. Participants reported missing an average of 1.06, 0.50, 0.91, 0.55 doses of ART in the past 7 days at baseline, 3-, 6-, and 9-month assessments, respectively. Most viral loads were ≥5,000 copies/ml at both baseline (68.6%) and 6-month assessments (54.3%). The incentive was divided between individual compensation for attending clinic and completing the assessment ($5 each, $20 in total) and a group-based compensation valued at $40 that was distributed during the 9-month assessment according to average group attendance (A≥90%, B≥75%, C≥60%, D<60%) and group-average viral load (A=undetectable, B=50-499, C=500-4999, D≥5,000). The mean earnings for the participants was $46.70 (77.8% of possible earning). Qualitative data suggested that the CEI helped ART adherence through gaining personal and group benefits. Participants reported no teasing, bullying, or other undesirable behaviors from group members. They liked getting money for attending clinics/group meetings and obtaining undetectable viral load. We concluded that a group-based CEI was safe and had the potential to improve ART adherence and reduce viral load among Ghanaian adolescents.
对抗逆转录病毒疗法（ART）依从性差会给青少年带来严重后果。有条件经济激励措施（CEI）是一种可能有助于应对这一挑战的方法。本研究评估了一项基于小组的CEI计划在提高加纳青少年样本中ART依从性方面的安全性和初步疗效。从一家HIV诊所招募了35名接受ART治疗（尽管病毒载量仍可检测到）的青少年（平均年龄：14.7岁），并将他们分成5个均衡的小组，在常规诊所就诊期间参与由同伴主导的基于小组的CEI活动。在基线以及3个月、6个月和9个月随访时的四次就诊中分别进行了四次评估。主要结果是ART依从性和病毒载量。采用线性混合模型和主题分析进行数据分析。大多数（91.4%）参与者参加了所有四项干预活动。参与者报告在基线、3个月、6个月和9个月评估时，过去7天平均分别漏服1.06剂、0.50剂、0.91剂和0.55剂ART。在基线（68.6%）和6个月评估时（54.3%），大多数病毒载量≥5000拷贝/ml。激励措施包括个人因就诊和完成评估获得的补偿（每次5美元，共20美元）以及在9个月评估时根据小组平均出勤率（A≥90%，B≥75%，C≥60%，D<60%）和小组平均病毒载量（A=不可检测，B=50 - 499，C=500 - 4999，D≥5000）分配的价值40美元的小组补偿。参与者的平均收入为46.70美元（占可能收入的77.8%）。定性数据表明，CEI通过获得个人和小组利益有助于提高ART依从性。参与者报告未受到小组成员的取笑、欺负或其他不良行为。他们喜欢因就诊/参加小组会议以及病毒载量不可检测而获得金钱。我们得出结论，基于小组的CEI是安全的，并且有可能提高加纳青少年的ART依从性并降低病毒载量。
