PDF(Pubmed)
Abstract：
Despite advances in HIV and HIV co-morbidity service delivery, substantial challenges remain in translating evidence-based interventions into routine practice to bring optimal care and prevention to all populations. While barriers to successful implementation are often multifactorial, healthcare worker behaviour is critical for on-the-ground and in-clinic service delivery. Implementation science offers a systematic approach to understanding service delivery, including approaches to overcoming delivery gaps. Behavioural economics is a field that seeks to understand when and how behaviour deviates from traditional models of decision-making, deviations which are described as biases. Clinical policies and implementation strategies that incorporate an understanding of behavioural economics can add to implementation science approaches and play an important role in bridging the gap between healthcare worker knowledge and service delivery.
In HIV care in low- and middle-income countries (LMICs), potential behavioural economic strategies that may be utilized alone or in conjunction with more traditional approaches include using choice architecture to exploit status quo bias and reduce the effects of cognitive load, overcoming the impact of anchoring and availability bias through tailored clinical training and clinical mentoring, reducing the effects of present bias by changing the cost-benefit calculus of interventions with few short-term benefits and leveraging social norms through peer comparison. As with any implementation strategy, understanding the local context and catalysts of behaviour is crucial for success.
As the focus of HIV care shifts beyond the goal of initiating patients on antiretroviral therapy to a more general retention in high-quality care to support longevity and quality of life, there is an increasing need for innovation to achieve improved care delivery and management. Clinical policies and implementation strategies that incorporate elements of behavioural economic theory, alongside local testing and adaptation, may increase the delivery of evidence-based interventions and improve health outcomes for people living with HIV in LMIC settings.
In HIV care in low- and middle-income countries (LMICs), potential behavioural economic strategies that may be utilized alone or in conjunction with more traditional approaches include using choice architecture to exploit status quo bias and reduce the effects of cognitive load, overcoming the impact of anchoring and availability bias through tailored clinical training and clinical mentoring, reducing the effects of present bias by changing the cost-benefit calculus of interventions with few short-term benefits and leveraging social norms through peer comparison. As with any implementation strategy, understanding the local context and catalysts of behaviour is crucial for success.
As the focus of HIV care shifts beyond the goal of initiating patients on antiretroviral therapy to a more general retention in high-quality care to support longevity and quality of life, there is an increasing need for innovation to achieve improved care delivery and management. Clinical policies and implementation strategies that incorporate elements of behavioural economic theory, alongside local testing and adaptation, may increase the delivery of evidence-based interventions and improve health outcomes for people living with HIV in LMIC settings.
摘要：
背景：尽管在艾滋病毒和艾滋病毒合并症服务提供方面取得了进展，在将基于证据的干预措施转化为常规实践以为所有人群提供最佳护理和预防方面，仍然存在重大挑战。虽然成功实施的障碍往往是多方面的，医护人员的行为对于实地和临床服务的提供至关重要。实施科学提供了一种系统的方法来理解服务交付，包括克服交付差距的方法。行为经济学是一个旨在了解行为何时以及如何偏离传统决策模型的领域，被描述为偏见的偏差。结合对行为经济学的理解的临床政策和实施策略可以增加实施科学方法，并在弥合医护人员知识和服务提供之间的差距方面发挥重要作用。
结论：在低收入和中等收入国家（LMICs）的艾滋病毒护理中，可能单独使用或与更传统方法结合使用的潜在行为经济策略包括使用选择架构来利用现状偏见并减少认知负荷的影响，通过量身定制的临床培训和临床指导，克服锚定和可用性偏见的影响，通过改变短期收益很少的干预措施的成本效益计算，并通过同行比较利用社会规范来减少当前偏见的影响。与任何实施策略一样，了解当地环境和行为的催化剂对成功至关重要。
结论：随着艾滋病毒护理的重点从患者开始接受抗逆转录病毒治疗的目标转移到更普遍的高质量护理中，以支持长寿和生活质量，越来越需要创新来改善护理服务和管理。纳入行为经济理论要素的临床政策和实施策略，除了本地测试和适应，可能会增加循证干预措施的实施，并改善LMIC环境中艾滋病毒感染者的健康结果。
结论：在低收入和中等收入国家（LMICs）的艾滋病毒护理中，可能单独使用或与更传统方法结合使用的潜在行为经济策略包括使用选择架构来利用现状偏见并减少认知负荷的影响，通过量身定制的临床培训和临床指导，克服锚定和可用性偏见的影响，通过改变短期收益很少的干预措施的成本效益计算，并通过同行比较利用社会规范来减少当前偏见的影响。与任何实施策略一样，了解当地环境和行为的催化剂对成功至关重要。
结论：随着艾滋病毒护理的重点从患者开始接受抗逆转录病毒治疗的目标转移到更普遍的高质量护理中，以支持长寿和生活质量，越来越需要创新来改善护理服务和管理。纳入行为经济理论要素的临床政策和实施策略，除了本地测试和适应，可能会增加循证干预措施的实施，并改善LMIC环境中艾滋病毒感染者的健康结果。
