Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK.
Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France.
J Int AIDS Soc. 2024 May;27(5):e26248. doi: 10.1002/jia2.26248.
INTRODUCTION: In South Africa, the HIV care cascade remains suboptimal. We investigated the impact of small conditional financial incentives (CFIs) and male-targeted HIV-specific decision-support application (EPIC-HIV) on the HIV care cascade. METHODS: In 2018, in uMkhanyakude district, 45 communities were randomly assigned to one of four arms: (i) CFI for home-based HIV testing and linkage to care within 6 weeks (R50 [US$3] food voucher each); (ii) EPIC-HIV which are based on self-determination theory; (iii) both CFI and EPIC-HIV; and (iv) standard of care. EPIC-HIV consisted of two components: EPIC-HIV 1, provided to men through a tablet before home-based HIV testing, and EPIC-HIV 2, offered 1 month later to men who tested positive but had not yet linked to care. Linking HITS trial data to national antiretroviral treatment (ART) programme data and HIV surveillance programme data, we estimated HIV status awareness after the HITS trial implementation, ART status 3 month after the trial and viral load suppression 1 year later. Analysis included all known individuals living with HIV in the study area including those who did not participated in the HITS trial. RESULTS: Among the 33,778 residents in the study area, 2763 men and 7266 women were identified as living with HIV by the end of the intervention period and included in the analysis. After the intervention, awareness of HIV-positive status was higher in the CFI arms compared to non-CFI arms (men: 793/908 [87.3%] vs. 1574/1855 [84.9%], RR = 1.03 [95% CI: 0.99-1.07]; women: 2259/2421 [93.3%] vs. 4439/4845 [91.6%], RR = 1.02 [95% CI: 1.00-1.04]). Three months after the intervention, no differences were found for linkage to ART between arms. One year after the intervention, only 1829 viral test results were retrieved. Viral suppression was higher but not significant in the EPIC-HIV intervention arms among men (65/99 [65.7%] vs. 182/308 [59.1%], RR = 1.11 [95% CI: 0.88-1.40]). CONCLUSIONS: Small CFIs can contribute to achieve the first step of the HIV care cascade. However, neither CFIs nor EPIC-HIV was sufficient to increase the number of people on ART. Additional evidence is needed to confirm the impact of EPIC-HIV on viral suppression.
简介：在南非，艾滋病毒护理链仍然不理想。我们研究了小额有条件经济激励（CFI）和针对男性的艾滋病毒特异性决策支持应用程序（EPIC-HIV）对艾滋病毒护理链的影响。 方法：2018 年，在乌姆克哈努克德区，将 45 个社区随机分为四组：（i）为家庭为基础的 HIV 检测和在 6 周内与护理联系提供的 CFI（每次检测提供 50 兰特[3 美元]的食品券）；（ii）基于自我决定理论的 EPIC-HIV；（iii）CFI 和 EPIC-HIV 两者；和（iv）标准护理。EPIC-HIV 由两部分组成：在家庭为基础的 HIV 检测前通过平板电脑提供给男性的 EPIC-HIV1，以及在 1 个月后提供给检测呈阳性但尚未与护理联系的男性的 EPIC-HIV2。将 HITS 试验数据与国家抗逆转录病毒治疗（ART）方案数据和艾滋病毒监测方案数据联系起来，我们估计了 HITS 试验实施后 HIV 阳性状态的知晓率、试验后 3 个月的 ART 状态和 1 年后的病毒载量抑制情况。分析包括研究地区所有已知的艾滋病毒感染者，包括未参加 HITS 试验的感染者。 结果：在研究地区的 33778 名居民中，在干预结束时，共有 2763 名男性和 7266 名女性被确定为艾滋病毒感染者，并纳入分析。干预后，CFI 组的 HIV 阳性状态知晓率高于非 CFI 组（男性：908/908 [87.3%] vs. 1855/1855 [84.9%]，RR=1.03[95%CI：0.99-1.07]；女性：2421/2421 [93.3%] vs. 4845/4845 [91.6%]，RR=1.02[95%CI：1.00-1.04]）。干预后 3 个月，各臂之间 ART 联系没有差异。干预后 1 年，仅检索到 1829 份病毒检测结果。干预后，男性中 EPIC-HIV 干预组的病毒抑制率更高，但无统计学意义（99/99 [65.7%] vs. 308/308 [59.1%]，RR=1.11[95%CI：0.88-1.40]）。 结论：小额 CFI 可以有助于实现艾滋病毒护理链的第一步。然而，CFI 或 EPIC-HIV 都不足以增加接受抗逆转录病毒治疗的人数。需要更多的证据来证实 EPIC-HIV 对病毒抑制的影响。
JMIR Mhealth Uhealth. 2020-11-24
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