Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia.
Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004, Australia; Bristol Medical School, University of Bristol, Bristol, United Kingdom.
Int J Drug Policy. 2024 Nov;133:104562. doi: 10.1016/j.drugpo.2024.104562. Epub 2024 Sep 18.
Reversing declining rates of people initiating and completing hepatitis C (HCV) treatment, observed in many countries, is needed to achieve global HCV elimination goals. Providing financial incentives to increase HCV testing and treatment uptake among people at-risk of or living with HCV infection could be an effective intervention. We conducted a systematic review to assess evidence regarding the effectiveness of financial incentives to improve engagement and progression through the HCV care cascade.
We searched MEDLINE, PubMed and EMBASE for studies published from January 2013 to January 2023 that evaluated financial incentives offered to people living with and at-risk of HCV to increase HCV antibody and or RNA testing, linkage to care, treatment initiation, treatment adherence, treatment completion, and sustained viral load (SVR) testing. Open-label randomised controlled trials (RCTs), controlled non-randomised studies, cohort or observation studies and mixed-methods studies were included, whereas literature reviews, case series and studies which did not report data were excluded.
We identified 1,278 studies, with 21 included after full-text screening (14,913 participants); three randomised controlled trials and 18 non-randomised studies. Studies evaluated incentives aimed at improving test uptake (n = 11), engagement in care (n = 13), treatment initiation (n = 8), adherence (n = 3), completion (n = 3) and attainment of SVR (n = 5). Findings provided inconclusive evidence for the effectiveness of incentives in improving engagement in the HCV cascade of care. Determining incentive effectiveness to improve care cascade engagement was limited by low quality study designs, heterogeneity in type (cash or voucher), value (US$5 to $600) and cascade stage being incentivised. No randomised controlled trials assessed the effectiveness of incentives to promote HCV testing, and none showed an impact on treatment uptake. In non-randomised studies (observational comparative), some evidence suggested that incentives promoted HCV testing, but evidence of their role in promoting linkage to care, HCV treatment adherence and treatment completion were mixed.
Currently, there lacks high-quality evidence evaluating whether financial incentives improve HCV testing and treatment outcomes. Future research should seek to standardise methodologies, compare incentive types and values to enhance engagement in HCV care, and determine factors that support incentives effectiveness.
许多国家观察到，开始接受和完成丙型肝炎（HCV）治疗的人数呈下降趋势，需要采取措施来实现全球 HCV 消除目标。为有 HCV 感染风险或已感染 HCV 的人提供经济激励，以增加 HCV 检测和治疗的采用率，这可能是一种有效的干预措施。我们进行了一项系统评价，以评估提供经济激励措施以提高 HCV 护理级联中参与度和进展的有效性。
我们在 MEDLINE、PubMed 和 EMBASE 中检索了 2013 年 1 月至 2023 年 1 月期间发表的评估向 HCV 感染者和有 HCV 感染风险的人提供经济激励措施，以增加 HCV 抗体和/或 RNA 检测、与护理机构的联系、治疗开始、治疗依从性、治疗完成和持续病毒载量（SVR）检测的有效性的研究。纳入了开放性随机对照试验（RCT）、对照非随机研究、队列或观察研究以及混合方法研究，而文献综述、病例系列和未报告数据的研究则被排除在外。
我们共确定了 1278 项研究，在全文筛选后有 21 项研究入选（14913 名参与者）；其中包括 3 项随机对照试验和 18 项非随机对照研究。这些研究评估了旨在提高检测利用率（n=11）、参与护理（n=13）、治疗开始（n=8）、依从性（n=3）、完成（n=3）和实现 SVR（n=5）的激励措施。研究结果提供了关于激励措施在提高 HCV 护理级联参与度方面有效性的不确定证据。由于研究设计质量低、激励类型（现金或代金券）、价值（5 至 600 美元）和激励级联阶段的异质性，难以确定激励措施在提高护理级联参与度方面的有效性。没有随机对照试验评估激励措施在促进 HCV 检测方面的有效性，也没有研究表明激励措施对治疗采用率有影响。在非随机研究（观察性比较）中，一些证据表明激励措施促进了 HCV 检测，但激励措施在促进与护理机构的联系、HCV 治疗依从性和治疗完成方面的作用存在差异。
目前，缺乏评估经济激励措施是否能改善 HCV 检测和治疗结果的高质量证据。未来的研究应努力使方法标准化，比较激励措施的类型和价值，以提高 HCV 护理的参与度，并确定支持激励措施有效性的因素。
