Incentivizing adherence to pre-exposure prophylaxis for HIV prevention: a randomized pilot trial among male sex workers in Mexico.

Autor: Galárraga O; Department of Health Services Policy and Practice, Brown University School of Public Health, 121 South Main St. Box G-S121-2, Providence, RI, 02903, USA. omar_galarraga@brown.edu.; International Health Institute, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA. omar_galarraga@brown.edu., Wilson-Barthes M; International Health Institute, Brown University School of Public Health, 121 South Main St, Providence, RI, 02903, USA., Chivardi C; National Institute of Public Health (INSP), University No. 655 Colonia Santa María Ahuacatitlán, Cuernavaca, Mexico.; Centre for Health Economics, University of York, Heslington, York, YO10 5DD, United Kingdom., Gras-Allain N; Center for HIV/AIDS Prevention and Care, Clínica Especializada Condesa, Gral. Benjamín Hill 24, Hipódromo Condesa Cuauhtémoc, México City, 06170, Mexico., Alarid-Escudero F; Center for Economics Teaching and Research (CIDE), Circuito Tecnopolo Norte #117, Col. Tecnopolo Pocitos II, Aguascalientes, CP, 20313, Mexico.; Stanford University School of Medicine, 291 Campus Drive Li Ka Shing Building, Stanford, CA, 94305, USA., Gandhi M; University of California, 1001 Potrero Ave, #423D, San Francisco, CA, 94110, USA., Mayer KH; The Fenway Institute, 7 Haviland St, Boston, MA, 02115, USA.; Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA., Operario D; Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, USA.
Jazyk: angličtina
Zdroj: The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2024 Jul 13. Date of Electronic Publication: 2024 Jul 13.
DOI: 10.1007/s10198-024-01705-y
Abstrakt: Low adherence to preventative medications against life-long health conditions is a major contributor to global morbidity and mortality. We implemented a pilot randomized controlled trial in Mexico to measure the extent to which conditional economic incentives help male sex workers increase their adherence to pre-exposure prophylaxis (PrEP) for HIV prevention. We followed n = 110 male sex workers over 6 months. At each quarterly visit (at months 0, 3, and 6), all workers received a $10 transport reimbursement, a free 3-month PrEP supply, and completed socio-behavioral surveys. The primary outcome was an objective biomarker of medication adherence based on tenofovir (TFV) drug concentration levels in hair collected at each visit. Individuals randomized to the intervention received incentives based on a grading system as a function of PrEP adherence: those with high (> 0.043 ng/mg TFV concentration), medium (0.011 to 0.042 ng/mg), or low (< 0.011 ng/mg) adherence received $20, $10, or $0, respectively. Six-month pooled effects of incentives on PrEP adherence were analyzed using population-averaged gamma generalized estimating equation models. We estimated heterogeneous treatment effects by sex worker characteristics. The incentive intervention led to a 28.7% increase in hair antiretroviral concentration levels over 6 months consistent with increased PrEP adherence (p = 0.05). The effect of incentives on PrEP adherence was greater for male sex workers who were street-based (vs. internet) workers (p < 0.10). These pilot findings suggest that modest conditional economic incentives could be effective, at scale, for improving PrEP adherence among male sex workers, and should be tested in larger implementation trials. ClinicalTrials.gov Identifier: NCT03674983.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
Databáze: MEDLINE
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