RAND Corporation, Santa Monica, USA.
IDinsight, San Francisco, USA.
Trials. 2023 Aug 9;24(1):511. doi: 10.1186/s13063-023-07449-z.
Treatment outcomes of HIV-positive individuals are threatened by low antiretroviral therapy (ART) adherence, a problem that is particularly acute among youth. Incentives are a promising tool to support ART adherence, but traditional incentive designs rewarding uniformly high levels of the desired health behavior may demotivate those with low levels of the behavior. In this study, we investigate the effectiveness of alternative approaches to target-setting for incentive eligibility using subgoals (i.e., individual-specific, interim targets leading up to the optimal target).
METHODS / DESIGN: We will enroll 628 HIV-positive youth between ages 15 and 30 into a 3-year randomized controlled trial. Participants will be randomized 1:1:1:1 to a control arm or one of three intervention arms (n = 157 each) that allow them to enter a prize drawing for small incentives if their ART adherence meets the given goal. In the first arm (T1, assigned subgoal), goals will be externally assigned and adapted to their initial adherence level. In the second arm (T2, participatory subgoal), participants can set their own interim goals. In the third arm (T3, fixed goal), all participants must reach the same target goal of 90% adherence. T1 and T2 participants are required to reach 90% adherence by month 12 to participate in a larger prize drawing. The control group receives the usual standard of care. All four groups will receive weekly motivational messages; the three treatment groups will additionally receive reminders of their upcoming prize drawing. Adherence will be measured continuously throughout the intervention period using electronic devices and for 12 months post-intervention. Surveys will be conducted at baseline and every 6 months. Viral loads will be measured annually. The primary outcome is Wisepill-measured adherence and a binary measure for whether the person took at least 90% of their pills. The secondary outcome is the log-transformed viral load as a continuous measure.
Our study is one of the first to apply insights about the psychology and behavioral economics of goal-setting to the design of incentives, by testing whether conditioning the eligibility threshold for incentives on subgoals (interim goals leading up to the ultimate, high goal) improves motivation and adherence more than setting a uniformly highly goal, and a comparison group.
ClinicalTrials.gov NCT05378607. Date of registration: May 18, 2022.
艾滋病毒阳性个体的治疗结果受到抗逆转录病毒疗法（ART）依从性低的威胁，而这一问题在年轻人中尤为突出。激励措施是支持 ART 依从性的一种有前途的工具，但传统的激励设计奖励理想健康行为的统一高水平可能会使那些行为水平较低的人失去动力。在这项研究中，我们调查了使用子目标（即达到最佳目标之前的特定于个人的、临时目标）来设定激励资格的替代目标设定方法的有效性。
方法/设计：我们将招募 628 名年龄在 15 至 30 岁之间的艾滋病毒阳性青年参加一项为期 3 年的随机对照试验。参与者将按照 1:1:1:1 的比例随机分配到对照组或三个干预组之一（每组 157 人），如果他们的 ART 依从性达到给定目标，他们将有资格参加小型激励抽奖。在第一组（T1，分配的子目标）中，目标将由外部设定并根据他们的初始依从水平进行调整。在第二组（T2，参与性子目标）中，参与者可以设定自己的临时目标。在第三组（T3，固定目标）中，所有参与者必须达到 90%的依从率相同的目标。T1 和 T2 组的参与者必须在第 12 个月达到 90%的依从率才能参加更大的抽奖。对照组接受常规的标准护理。所有四组都将每周收到激励信息；三组治疗组将另外收到即将到来的抽奖提醒。依从性将使用电子设备在整个干预期间连续测量，并在干预后 12 个月进行测量。基线时和每 6 个月进行一次调查。每年测量一次病毒载量。主要结果是 Wisepill 测量的依从性和是否服用至少 90%的药物的二分法测量。次要结果是作为连续测量的对数转换病毒载量。
我们的研究是首批应用关于目标设定的心理学和行为经济学见解来设计激励措施的研究之一，通过测试根据子目标（达到最终高目标之前的临时目标）调整激励资格的资格标准是否比设定统一的高标准更能提高动机和依从性，并与对照组进行比较。
ClinicalTrials.gov NCT05378607。注册日期：2022 年 5 月 18 日。
