RAND Corporation, Santa Monica, CA.
Mildmay Uganda Hospital, Kampala, Uganda .
J Acquir Immune Defic Syndr. 2024 Jul 1;96(3):250-258. doi: 10.1097/QAI.0000000000003420.
This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with 1 approach being low cost.
Three hundred twenty-nine adults at Mildmay Hospital in Kampala, Uganda, on ART for at least 2 years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown.
We randomized participants into 1 of 3 (1:1:1) groups: usual care ("control" group; n = 109) or 1 of 2 intervention groups where eligibility for nonmonetary prizes was based on showing at least 90% electronically measured ART adherence ("adherence-linked" group, n = 111) or keeping clinic appointments as scheduled ("clinic-linked"; n = 109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777 .
Neither incentive arm increased adherence compared with the control; we estimate a 3.9 percentage point increase in "adherence-linked" arm [95% confidence interval (CI): -0.70 to 8.60 ( P = 0.10)] and 0.024 in the "clinic-linked" arm [95% CI: -0.02 to 0.07 ( P = 0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI: 0.01, 0.15; P = 0.04, "adherence-linked") and 5.60 percentage points (95% CI: -0.01, 0.12; P = 0.10, "clinic-linked"). We find no effects on clinic attendance or viral suppression.
Incentives did not improve viral suppression or ART adherence overall but worked for the prespecified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.
本研究旨在通过行为经济学激励措施来提高抗逆转录病毒治疗（ART）的依从性，其中一种方法是低成本。
乌干达坎帕拉的米尔德梅医院（Mildmay Hospital）的 329 名成年人，他们至少接受了 2 年的 ART 治疗，并表现出依从性问题，他们接受了大约 15 个月的干预措施，直到该研究因全国范围内的 COVID-19 封锁而中断。
我们将参与者随机分为 3 组（1:1:1）：常规护理（“对照组”；n = 109）或 2 个干预组之一，其中非货币奖励的资格基于至少 90%的电子测量 ART 依从性（“依从性相关”组，n = 111）或按计划就诊（“诊所相关”组；n = 109）。12 个月后，参与者可以因持续高依从性或病毒抑制而赢得更大的奖励。主要结果是平均依从性和病毒抑制率。分析采用意向治疗的线性回归。该试验在 ClinicalTrials.gov 注册，NCT03494777。
与对照组相比，激励措施都没有增加依从性；我们估计“依从性相关”组增加了 3.9 个百分点[95%置信区间（CI）：-0.70 至 8.60（P = 0.10）]，“诊所相关”组增加了 0.024[95% CI：-0.02 至 0.07（P = 0.28）]。对于最初依从性较低的特定亚组，激励措施使依从性增加了 7.60 个百分点（95% CI：0.01，0.15；P = 0.04，“依从性相关”）和 5.60 个百分点（95% CI：-0.01，0.12；P = 0.10，“诊所相关”）。我们没有发现对就诊次数或病毒抑制的影响。
激励措施总体上并没有改善病毒抑制或 ART 依从性，但对于最初依从性较低的特定亚组有效。更有效地确定需要依从性支持的人群，将有助于更好地针对这一人群和其他激励措施。
