Parklands Kidney Center, Nairobi, Kenya.
Aga Khan University Hospital, Nairobi, Kenya.
AIDS Behav. 2023 Oct;27(10):3521-3534. doi: 10.1007/s10461-022-03969-y. Epub 2023 Feb 14.
Failure to meet international targets set for the human immunodeficiency virus HIV pandemic suggests that more effective public health strategies are needed. New strategies informed by behavioural economics are now increasingly being tested, with promising results. However, the evidence base is diverse and challenging for policymakers to interpret. This paper aims to synthesise existing evidence by reporting results from a systematic review of behavioural economics-based interventions for addressing HIV prevention, testing and treatment. The reported study was a systematic review of randomized controlled trials. The search was conducted in four electronic medical literature databases, six trial registries, four grey literature sources and was not restricted to any country or region. Bias was assessed using criteria outlined in the Cochrane Handbook for Systematic Reviews; quality of evidence was assessed using GRADE methodology. Fifteen full text articles were included in the final analysis. The synthesis of these studies revealed that strategies involving opt-out defaults, active-choice defaults, and lottery incentives can potentially increase uptake of HIV testing. Lottery incentives also showed signs of effectiveness in improving HIV prevention, ART adherence and initiation. Despite the promising findings, the overall evidence was judged to be of moderate to very low quality. Behavioural economics-based interventions are promising behavioural change strategies, although more well-designed studies are needed to strengthen the evidence base.
未能实现国际社会为应对人类免疫缺陷病毒（HIV）大流行而设定的目标，表明需要采取更有效的公共卫生策略。现在，越来越多的新策略正在接受行为经济学的检验，并取得了可喜的成果。然而，证据基础多样，给政策制定者的解读带来了挑战。本文旨在通过报告一项针对基于行为经济学的干预措施以解决 HIV 预防、检测和治疗问题的系统评价的结果，综合现有证据。本报告研究是一项基于行为经济学的干预措施的系统评价，对随机对照试验进行了检索。检索在四个电子医学文献数据库、六个试验登记处、四个灰色文献来源中进行，不限于任何国家或地区。使用 Cochrane 系统评价手册中概述的标准评估偏倚；使用 GRADE 方法评估证据质量。最终分析中纳入了 15 篇全文文章。这些研究的综合结果表明，涉及默认选择、主动选择默认和彩票激励的策略可能会增加 HIV 检测的接受率。彩票激励也显示出在改善 HIV 预防、ART 依从性和启动方面的有效性迹象。尽管有很有前途的发现，但总体证据质量被认为是中等至非常低。基于行为经济学的干预措施是很有前途的行为改变策略，但需要更多精心设计的研究来加强证据基础。
