鼓励坚持性别肯定的PrEP项目：跨性别和性别非二元成人的陈述偏好离散选择实验。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making Pub Date : 2025-11-01 Epub Date: 2025-08-16 DOI:10.1177/0272989X251355971

Marta G Wilson-Barthes, Arjee Javellana Restar, Don Operario, Omar Galárraga

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引用次数: 0

摘要

目的：跨性别（trans）人群的艾滋病毒感染风险高得不成比例，但这一人群对暴露前预防（PrEP）的依从性仍然很低。我们的目的是确定哪些因素对hiv阴性的跨性别成年人坚持长效注射PrEP （LA-PrEP）的决定最重要，以及以LA-PrEP项目参与为条件提供激励的可接受性。方法：2023年3月至4月，华盛顿州385名跨性别成年人完成了一项离散选择实验（DCE），以诱导他们对有条件的经济激励计划的偏好，该计划将在两个月的访问期间提供免费的LA-PrEP和性别确认护理。我们在两个具有选择退出选项的假设程序中使用了最佳偏好激发方法。项目属性包括激励形式和金额，确定PrEP依从性的方法，以及激素联合处方的类型。我们对主要结果使用了一个秩序混合logit模型，并估计了受访者接受每个计划属性的边际意愿。我们绘制了选择受激励的LA-PrEP计划的概率在一系列受访者的特征。结果最优方案设计为：1)现金奖励，2)通过血液检测确认PrEP依从性，3)当面咨询，4)提供注射性别肯定激素处方。从每年1200美元的最高奖励金额，受访者愿意放弃高达689美元的现金奖励（而不是代金券）和高达547美元的注射（而不是口服）激素。随着成年人年龄的增长（40 - 40岁）和收入的增加（7.5万美元/年），选择假想项目的概率比没有项目的概率下降。结论有条件的经济激励对于提高LA-PrEP依从性可能是可接受和有效的，特别是在经济资源较少的年轻变性人中。需要一项随机试验来证实DCE在预测实际项目吸收方面的有效性。强调与性别相关的污名、经济障碍和对激素相互作用的医学担忧可能使跨性别（跨性别）成年人不参与艾滋病毒预防行为。将性别确认护理与有条件的经济激励相结合，可能有助于减少目前的偏见，并增加跨性别者坚持长效注射暴露前预防（LA-PrEP）的动力。从每年最高1200美元的奖励中，跨性别离散选择实验的受访者愿意放弃高达689美元的现金奖励（而不是代金券），以及高达547美元的联合处方，以获得注射（而不是口服）激素，作为假设的艾滋病毒预防计划的一部分。选择LA-PrEP项目的可能性随着成年人年龄的增长（40 - 40岁）和年收入的增加（7.5万美元/年）而开始下降，因此，有激励的LA-PrEP项目可能对经济资源较少的年轻变性人尤其突出。

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Incentivizing Adherence to Gender-Affirming PrEP Programs: A Stated Preference Discrete-Choice Experiment among Transgender and Gender Nonbinary Adults.

ObjectivesTransgender (trans) people have disproportionately high HIV risk, yet adherence to preexposure prophylaxis (PrEP) remains low in this population. We aimed to determine which factors matter most in the decision of HIV-negative transgender adults to adhere to long-acting injectable PrEP (LA-PrEP), and the acceptability of providing incentives conditional on LA-PrEP program engagement.MethodsFrom March to April 2023, 385 trans adults in Washington State completed a discrete-choice experiment (DCE) eliciting preferences for a conditional economic incentive program that would provide free LA-PrEP and gender-affirming care during bimonthly visits. We used the best-best preference elicitation method across 2 hypothetical programs with an opt-out option. Program attributes included incentive format and amount, method for determining PrEP adherence, and type of hormone co-prescription. We used a rank-ordered mixed logit model for main results and estimated respondents' marginal willingness to accept each program attribute. We plotted the probability of choosing an incentivized LA-PrEP program over a range of respondent characteristics.ResultsThe optimal program design would 1) deliver incentives in cash, 2) confirm PrEP adherence via blood testing, 3) provide counseling in person, and 4) provide prescriptions for injectable gender-affirming hormones. From a maximum incentive amount of $1,200/year, respondents were willing to forgo up to $689 to receive incentives in cash (instead of voucher) and up to $547 to receive injectable (instead of oral) hormones. The probability of choosing a hypothetical program over no program waned as adults aged (>40 y) and as income increased (>$75,000/y).ConclusionsConditional economic incentives are likely acceptable and effective for improving LA-PrEP adherence, especially among younger trans adults with fewer financial resources. A randomized trial is needed to confirm the DCE's validity for predicting actual program uptake.HighlightsGender-related stigma, economic barriers, and medical concerns about hormone interactions can keep transgender (trans) adults from engaging in HIV prevention behaviors.Combining gender-affirming care with conditional economic incentives may help reduce present bias and increase trans persons' motivation to adhere to long-acting injectable preexposure prophylaxis (LA-PrEP).From a maximum yearly incentive of $1,200, trans discrete-choice experiment respondents were willing to forgo up to $689 to receive a cash (rather than voucher) incentive and up to $547 to receive co-prescriptions for injectable (rather than oral) hormones as part of a hypothetical HIV prevention program.The probability of choosing an LA-PrEP program over no program begins to wane as adults age (>40 y) and as annual income increases (>$75,000/year), such that incentivized LA-PrEP programs may be especially salient for younger trans adults with fewer financial resources.

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来源期刊

Medical Decision Making 医学-卫生保健

CiteScore

6.50

自引率

5.60%

发文量

146

审稿时长

6-12 weeks

期刊介绍： Medical Decision Making offers rigorous and systematic approaches to decision making that are designed to improve the health and clinical care of individuals and to assist with health care policy development. Using the fundamentals of decision analysis and theory, economic evaluation, and evidence based quality assessment, Medical Decision Making presents both theoretical and practical statistical and modeling techniques and methods from a variety of disciplines.