Louisiana Public Health Institute, New Orleans, LA 70130, USA.
School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA.
Int J Environ Res Public Health. 2022 Aug 2;19(15):9486. doi: 10.3390/ijerph19159486.
Economic strengthening interventions are needed to support HIV outcomes among persons living with HIV (PLWH). The Baton Rouge Positive Pathway Study (BRPPS), a mixed method implementation science study, was conducted to assess key RE-AIM components tied to the provision of conditional financial incentives among PLWH in Baton Rouge, Louisiana. Seven hundred and eighty-one (781) PLWH enrolled at four HIV clinic sites were included in the final analyses. Participants completed an initial baseline survey, viral load test, and were contacted at 6 and 12 months (±1 month) post-enrollment for follow-up labs to monitor viral load levels. Participants received up to USD140 in conditional financial incentives. The primary analyses assessed whether participation in the BRPPS was associated with an increase in the proportion of participants who were: (a) engaged in care, (b) retained in care and (c) virally suppressed at baseline to 6 and 12 months post-baseline. We constructed a longitudinal regression model where participant-level outcomes at times t0 (baseline) and t1 (6- or 12-month follow-up) were modeled as a function of time. A secondary analysis was conducted using single-level regression to examine which baseline characteristics were associated with the outcomes of interest at 12-month follow-up. Cost analyses were also conducted with three of the participating clinics. Most participants identified as Black/African American (89%). Fewer than half of participants reported that they were unemployed or made less than USD5000 annually (43%). Over time, the proportion of participants engaged in care and retained in care significantly increased (70% to 93% and 32% to 64%, p < 0.00). However, the proportion of virally suppressed participants decreased over time (59% to 34%, p < 0.00). Implementation costs across the three sites ranged from USD17,198.05 to USD396,910.00 and were associated with between 0.37 and 1.34 HIV transmissions averted at each site. Study findings provide promising evidence to suggest that conditional financial incentives could help support engagement and retention in HIV care for a high need and at risk for falling out of HIV care population.
需要经济强化干预措施来支持艾滋病毒感染者（PLWH）的艾滋病毒结局。巴吞鲁日积极途径研究（BRPPS）是一项混合方法实施科学研究，旨在评估与路易斯安那州巴吞鲁日 PLWH 提供有条件经济激励措施相关的关键 RE-AIM 组成部分。共有 781 名 PLWH 在四个艾滋病毒诊所参加了最终分析。参与者完成了初始基线调查、病毒载量检测，并在登记后 6 个月和 12 个月（±1 个月）进行随访实验室检测以监测病毒载量水平。参与者最多可获得 140 美元的有条件经济激励。主要分析评估了参加 BRPPS 是否与以下方面参与者比例的增加有关：(a) 参与护理，(b) 保留在护理中，以及 (c) 在基线时到 6 个月和 12 个月时病毒载量抑制。我们构建了一个纵向回归模型，其中参与者在 t0（基线）和 t1（6 或 12 个月随访）时的个体水平结果被建模为时间的函数。使用单水平回归进行了二次分析，以检查哪些基线特征与 12 个月随访时的感兴趣结果相关。还对三个参与诊所进行了成本分析。大多数参与者是黑人/非裔美国人（89%）。不到一半的参与者报告他们失业或年收入低于 5000 美元（43%）。随着时间的推移，参与护理和保留护理的参与者比例显著增加（70%至 93%和 32%至 64%，p < 0.00）。然而，病毒载量抑制的参与者比例随着时间的推移而下降（59%至 34%，p < 0.00）。三个地点的实施成本从 17198.05 美元到 396910.00 美元不等，每个地点的 HIV 传播减少了 0.37 到 1.34 次。研究结果提供了有希望的证据，表明有条件的经济激励措施可能有助于支持艾滋病毒感染者的护理参与和保留，对于高需求和有因护理而脱失风险的人群。
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