Historique
Article de Périodique
Use of contingency management incentives to improve completion of hepatitis B vaccination in people undergoing treatment for heroin dependence: a cluster randomised trial (2014)
Auteur(s) :
WEAVER, T. ;
METREBIAN, N. ;
HELLIER, J. ;
PILLING, S. ;
CHARLES, V. ;
LITTLE, N. ;
POOVENDRAN, D. ;
MITCHESON, L. ;
RYAN, F. ;
BOWDEN-JONES, O. ;
DUNN, J. ;
GLASPER A. ;
FINCH, E. ;
STRANG, J.
Année
2014
Page(s) :
153-163
Langue(s) :
Anglais
Refs biblio. :
36
Domaine :
Drogues illicites / Illicit drugs
Discipline :
MAL (Maladies infectieuses / Infectious diseases)
Thésaurus mots-clés
USAGER
;
HEPATITE
;
VACCINATION
;
ETUDE RANDOMISEE
;
OBSERVANCE DU TRAITEMENT
;
FINANCEMENT
Thésaurus géographique
ROYAUME-UNI
Note générale :
* Comment: Should at-risk patients be paid to receive interventions? McLellan A.T., p. 113-114.
* Correspondence:
Hepatitis B vaccination for people who inject drugs. Haber P.S., Day C.A., Topp L., Shanahan M., Wand H., van Beek I., et al. The Lancet, 2015;385(9963): p. 115.
Hepatitis B vaccination for people who inject drugs. Hope V.D., Mandal S., Cullen K.J., Balogun K., Ncube F. The Lancet, 2015;385(9963): p. 115-116.
Hepatitis B vaccination for people who inject drugs - Authors' reply. Weaver T., Metrebian N., Strang J. The Lancet, 2015;385(9963): p. 116.
* Correspondence:
Hepatitis B vaccination for people who inject drugs. Haber P.S., Day C.A., Topp L., Shanahan M., Wand H., van Beek I., et al. The Lancet, 2015;385(9963): p. 115.
Hepatitis B vaccination for people who inject drugs. Hope V.D., Mandal S., Cullen K.J., Balogun K., Ncube F. The Lancet, 2015;385(9963): p. 115-116.
Hepatitis B vaccination for people who inject drugs - Authors' reply. Weaver T., Metrebian N., Strang J. The Lancet, 2015;385(9963): p. 116.
Résumé :
BACKGROUND. Poor adherence to treatment diminishes its individual and public health benefit. Financial incentives, provided on the condition of treatment attendance, could address this problem. Injecting drug users are a high-risk group for hepatitis B virus (HBV) infection and transmission, but adherence to vaccination programmes is poor. We aimed to assess whether contingency management delivered in routine clinical practice increased the completion of HBV vaccination in individuals receiving opioid substitution therapy.
METHODS. In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493.
FINDINGS. Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12.1, 95% CI 3.7-39.9; p<0.0001), as did 32 (49%) of 65 participants in the escalating value contingency management group (14.0, 4.2-46.2; p<0.0001). These differences remained significant with sensitivity analyses.
INTERPRETATION. Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown.
METHODS. In our cluster randomised controlled trial, we enrolled participants at 12 National Health Service drug treatment services in the UK that provided opioid substitution therapy and nurse-led HBV vaccination with a super-accelerated schedule (vaccination days 0, 7, and 21). Clusters were randomly allocated 1:1:1 to provide vaccination without incentive (treatment as usual), with fixed value contingency management (three £10 vouchers), or escalating value contingency management (£5, £10, and £15 vouchers). Both contingency management schedules rewarded on-time attendance at appointments. The primary outcome was completion of clinically appropriate HBV vaccination within 28 days. We also did sensitivity analyses that examined vaccination completion with full adherence to appointment times and within a 3 month window. The trial is registered with Current Controlled Trials, number ISRCTN72794493.
FINDINGS. Between March 16, 2011, and April 26, 2012, we enrolled 210 eligible participants. Compared with six (9%) of 67 participants treated as usual, 35 (45%) of 78 participants in the fixed value contingency management group met the primary outcome measure (odds ratio 12.1, 95% CI 3.7-39.9; p<0.0001), as did 32 (49%) of 65 participants in the escalating value contingency management group (14.0, 4.2-46.2; p<0.0001). These differences remained significant with sensitivity analyses.
INTERPRETATION. Modest financial incentives delivered in routine clinical practice significantly improve adherence to, and completion of, HBV vaccination programmes in patients receiving opioid substitution therapy. Achievement of this improvement in routine clinical practice should now prompt actual implementation. Drug treatment providers should employ contingency management to promote adherence to vaccination programmes. The effectiveness of routine use of contingency management to achieve long-term behaviour change remains unknown.
Affiliation :
Centre for Mental Health, Imperial College London, London, UK