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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.

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This study addresses the challenge of low blood donation rates in developing countries by examining the effectiveness of a barrier-removal incentive-a one-day transportation voucher-to promote blood donation. Utilizing a longitudinal dataset of 23,750 donors from a Brazilian blood collection agency (BCA) collected between March 2018 and May 2020, we examine the short and long-term effects of this campaign on donation rates. Our results show that the incentive had a large positive influence on both donation attempts and successful donations on the day of the campaign. However, the short-term success of the intervention had an unintended consequence: the significant increase in prospective donors' waiting time at the BCA during the intervention day, which may help explain the negative impact on return rates in the 24-month follow-up. Despite these opposing outcomes, the net effect of the one-day blood donation incentive was still positive, offering valuable insights for BCAs aiming to enhance donor recruitment and retention strategies and emphasizing the need to balance immediate benefits with potential long-term impacts.

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En Guatemala, los huevos de tortuga parlama son aprovechados para su comercialización. El esquema de conservación se basa en un sistema de cuotas, en la que se establece que el 20% de los huevos recolectados deberán ser entregados a un tortugario registrado. Se estima que alrededor de 673,304 huevos son puestos por año en la Costa Pacífica con un valor en playa aproximado de Q1,124,869.00. En Guatemala, el aprovechamiento de huevos de tortuga funciona como un amortiguador clave en las economías de las comunidades. En los últimos años, la compra de huevos por parte de los tortugarios ha aumentado. Estos criaderos, además de recibir la cuota de conservación, compran el resto de la carga de huevos del nido. Como resultado, el número de nidos plantados en los tortugarios también ha aumentado. Sin embargo, esto también ha provocado que haya un mercado mas grande para los huevos de tortuga. La venta de huevos se ha convertido en una fuente de ingresos muy exitosa con menos riesgo y costos que la pesca. Esto ha llevado a algunos pescadores artesanales a cambiar a la recolección de huevos como su actividad principal. Es necesario evaluar los esquemas de conservación actuales y la efectividad de los incentivos de manera integral, tomando en cuenta impactos ambientales, rentabilidad y efectos sociales. El presente análisis aporta información útil para identificar la calidad de los incentivos, para poder reformar o eliminar los incentivos ineficientes o perversos, de manera que los escasos recursos de conservación se puedan invertir de la manera más efectiva

In Guatemala, olive ridley sea turtle (Lepidochelys olivacea) eggs are harvested. The conservation scheme is based Modelo de publicación sin fines de lucro para conservar la naturaleza académica y abierta de la comunicación científica on a quota system, which requires that 20% of the collected eggs be delivered to a registered turtle nursery. It is estimated that approximately 673,304 eggs are laid annually on the Pacific coast, with an approximate beach value of Q1,124,869.00. In Guatemala, the harvesting of turtle eggs serves as a key buffer in the economies of coastal communities. In recent years, the purchase of eggs by turtle nurseries has increased. These nurseries, in addition to receiving the conservation fee, buy the rest of the load of eggs from the nest. As a result, the number of planted nests in nurseries has also increased. However, this has also led to a larger market for turtle eggs. The sale of eggs. The sale of eggs has become a highly successful source of income, with fewer risks and costs than fishing. This has led some artisanal fishermen to switch to egg collection as their main activity. This analysis provides useful infromation for identifying the quality of incentives, in order to reform or elinate inefficient or perverse incentives, so that scarce conservation resource will allow for the identification of the quality of the incentives, aiming to reform or eliminate inefficient or perverse incentives so that scarce conservation resources can be invested in the most effective way

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Objetivo: A tecnologia assistiva (TA) busca suprir ou reduzir o impacto das deficiências na execução de tarefas da vida cotidiana. Embora muitas pessoas necessitem de TA, em 2021, a OMS estimou que apenas uma em cada dez pessoas tinha acesso a ela. Com a oferta retraída e a demanda em alta, observou-se um movimento mundial crescente de inovações em TA e a abertura de um cenário de oportunidades para esse mercado. O objetivo deste artigo é avaliar o mercado de TA no Brasil e as projeções futuras, no cenário mundial. Métodos: A pesquisa foi realizada em três etapas. Primeiramente, foi realizado um estudo bibliográfico do Livro Branco da Tecnologia Assistiva no Brasil (2017), para reconhecimento dos desafios do mercado brasileiro. Em seguida, foi realizado um estudo sobre o cenário de crédito nacional, com foco em financiamento de TA. Para compreensão do mercado mundial, foi realizada uma pesquisa nos sites de análise de mercado de TA. Resultados: Há escassez de TA no Brasil. Os principais fornecedores são pequenas e médias empresas, e são escassos os incentivos fiscais e de crédito, assim como os investimentos em pesquisa, desenvolvimento e inovação. Em escala mundial, o mercado de TA foi avaliado em US$ 21,95 bilhões de dólares em 2022, devendo atingir o valor de US$ 31,22 bilhões de dólares até o ano de 2030. Conclusão: O mercado mundial de TA está em franca expansão e apresenta grande potencial de abertura para novos mercados. Esse cenário reflete um momento de oportunidades de negócio para as empresas nacionais.

Objective: Assistive Technology (AT) seeks to overcome or reduce the impact of deficiencies when performing everyday tasks. Although many people needed AT, in 2021, the WHO estimated that only one in ten people had access. With reduced supply and rising demand, a growing global movement of AT innovations was inspired, opening up a scenario of opportunities for this market. The objective of this study is to evaluate the AT market in Brazil and future projections on the global stage. Methods: The research was carried out in three stages. Firstly, a bibliographical study of the "White Book of Assistive Technology in Brazil" was carried out to recognize the challenges of the Brazilian market. Next, a study was carried out on the national credit scenario, focusing on TA financing. To understand the global market, research was carried out on TA market analysis websites. Results: There is a shortage of AT in Brazil. The main suppliers are small and medium-sized companies, and tax and credit incentives, as well as investments in Research, Development and Innovation, are scarce. On a global scale, the AT market was valued at US$ 21.95 billion in 2022, and is expected to reach a value of US$ 31.22 billion by the year 2030. Conclusion: The global AT market is in rapid expansion and presents great potential for opening up new markets. This scenario reflects a moment of business opportunities for national companies.

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The amount and characterization of municipal and industrial waste generated in numerous cities worldwide have changed dramatically in recent years due to the COVID-19 pandemic. Consequently, assessing the impact of COVID-19-related policies is important to provide decision-makers with adequate knowledge to respond effectively to future events and create successful policies that respond to specific contexts. This study focuses on Chile, Latin America's second-largest municipal and industrial solid waste producer, with tight quarantine procedures placed to prevent the virus from spreading, and a series of monetary incentives implemented to minimize the economic and social impact of the quarantines. The time series of municipal solid waste (MSW) and recycling in the metropolitan region show a decrease in the amount collected during the initial months of lockdown and a subsequent increase during monetary incentive implementation. The country recovered and exceeded pre-pandemic MSW generation and recycling levels. Furthermore, the lockdown and the withdrawal of retirement funds (WRF) had a varied impact on each municipality in the region. However, WRF had a larger direct impact than a lockdown, indicating that purchasing power has a greater impact than mobility in waste generation and recycling, at least in this region of Chile.

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Privately protected areas (PPAs) are a potentially innovative conservation tool. Legal recognition is necessary for their success, especially where there are institutional challenges to nature conservation, such as in South America. Although PPAs have increased in South America since the early 2000s, there is a critical information gap pertaining to their legal frameworks. We analyzed the level of landowner commitment to and governmental support for PPAs across countries in South America that officially recognize PPAs. We analyzed the legal framework governing PPAs and reviewed literature on them. This process was done in English and Spanish. The information we gathered was validated by 16 conservation experts from 10 South American countries. Because Peru is 1 of only 2 South American countries where local communities create and manage PPAs, we studied Peruvian PPAs in more detail by examining official creation documents and interviewing 13 local conservation professionals. We found inadequate minimum duration of PPAs and vague guidelines for conducting economic activities within them and a lack of governmental support (e.g., financial and technical support) for PPAs. Support was limited to the exemption from rural property taxes, which are relatively low compared with countries outside South America. In Peru, PPAs run by individuals and communities needed different legal frameworks because they were created with different objectives and had different sizes and duration of commitments. The prompt improvement of legal frameworks across South America is necessary for PPAs to achieve their aim of being places for enduring nature conservation in the region.

Una revisión legal de la conservación voluntaria entierras privadas de América del Sur Resumen Las áreas protegidas privadas (APP) son una herramienta de conservación con potencial innovador. Para ser exitosas, las APP necesitan reconocimiento legal, especialmente cuando existen obstáculos institucionales para la conservación de la naturaleza, como sucede en América del Sur. Aunque las APP han aumentado en esta zona desde principios de la década del 2000, existe un vacío de información con respecto a sus marcos legales. Analizamos el nivel de compromiso de los terratenientes y el apoyo gubernamental hacia las APP en los países de América del Sur que reconocen de forma oficial las APP. Analizamos el encuadre legal que rige a las APP y revisamos la literatura existente sobre ellas; realizamos este proceso en inglés y en español. Dieciséis expertos de la conservación de diez países sudamericanos validaron la información recopilada. Ya que Perú es uno de los dos países de la zona en donde las comunidades locales crean y manejan las APP, nos enfocamos en sus APP y examinamos a detalle los documentos oficiales de creación y entrevistamos a 13 profesionales de la conservación locales. Encontramos una duración mínima inadecuada de las APP y directrices vagas para la realización de actividades dentro de ellas, así como una falta de apoyo gubernamental (p. ej.: apoyo económico y técnico). Este apoyo se limitaba a la exención de los impuestos sobre la propiedad rural, los cuales son relativamente bajos en comparación con los países fuera de América del Sur. En Perú, las APP a cargo de individuos y comunidades necesitaban diferentes encuadres legales porque fueron creados con diferentes objetivos y tenían diferentes tamaños y plazos para los compromisos. Se necesita una rápida mejora de los marcos legales en América del Sur para que las APP logren el objetivo de ser sitios para que perdure la conservación de la naturaleza en la región.

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Pay-for-performance (P4P) has been widely applied in OECD countries to improve the quality of both primary and secondary care, and is increasingly being implemented in low- and middle-income countries. In 2011, Brazil introduced one of the largest P4P schemes in the world, the National Programme for Improving Primary Care Access and Quality (PMAQ). We critically assess the design of PMAQ, drawing on a comparison with England's quality and outcome framework which, like PMAQ, was implemented at scale relatively rapidly within a nationalised health system. A key feature of PMAQ was that payment was based on the performance of primary care teams but rewards were given to municipalities, who had autonomy in how the funds could be used. This meant the incentives felt by family health teams were contingent on municipality decisions on whether to pass the funds on as bonuses and the basis upon which they allocated the funds between and within teams. Compared with England's P4P scheme, performance measurement under PMAQ focused more on structural rather than process quality of care, relied on many more indicators, and was less regular. While PMAQ represented an important new funding stream for primary health care, our review suggests that theoretical incentives generated were unclear and could have been better structured to direct health providers towards improvements in quality of care.

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Incentives are a useful tool in encouraging healthy behavior as part of public health initiatives. However, there remains concern about motivation crowd out-a decline in levels of motivation to undertake a behavior to below baseline levels after incentives have been removed-and few public health studies have assessed for motivation crowd out. Here, we assess the feasibility of identifying motivation crowd out following a lottery to promote participation in a Chagas disease vector control campaign. We look for evidence of crowd out in subsequent participation in the same behavior, a related behavior, and an unrelated behavior. We identified potential motivation crowd out for the same behavior, but not for related behavior or unrelated behaviors after lottery incentives are removed. Despite some limitations, we conclude that motivation crowd out is feasible to assess in large-scale trials of incentives.

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Background: Financial incentives may improve the initiation and engagement of behaviour change that reduce the negative outcomes associated with non-communicable diseases. There is still a paucity in guidelines or recommendations that help define key aspects of incentive-oriented interventions, including the type of incentive (e.g. cash rewards, vouchers), the frequency and magnitude of the incentive, and its mode of delivery.  We aimed to systematically review the literature on financial incentives that promote healthy lifestyle behaviours or improve health profiles, and focused on the methodological approach to define the incentive intervention and its delivery. The protocol was registered at PROSPERO on 26 July 2018 ( CRD42018102556). Methods: We sought studies in which a financial incentive was delivered to improve a health-related lifestyle behaviour (e.g., physical activity) or a health profile (e.g., HbA1c in people with diabetes). The search (which took place on March 3 rd 2018) was conducted using OVID (MEDLINE and Embase), CINAHL and Scopus. Results: The search yielded 7,575 results and 37 were included for synthesis. Of the total, 83.8% (31/37) of the studies were conducted in the US, and 40.5% (15/37) were randomised controlled trials. Only one study reported the background and rationale followed to develop the incentive and conducted a focus group to understand what sort of incentives would be acceptable for their study population. There was a degree of consistency across the studies in terms of the direction, form, certainty, and recipient of the financial incentives used, but the magnitude and immediacy of the incentives were heterogeneous. Conclusions: The available literature on financial incentives to improve health-related lifestyles rarely reports on the rationale or background that defines the incentive approach, the magnitude of the incentive and other relevant details of the intervention, and the reporting of this information is essential to foster its use as potential effective interventions.

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In Argentina, cardiovascular disease (CVD) represents the first cause of mortality, but effective coverage for CVD prevention is low. Strategies based on behavioral economics are emerging worldwide as key pieces to increase the effectiveness of CVD prevention approaches. The aim of this study was to evaluate whether the implementation of two strategies based on financial incentives and framing increased attendance to clinical visits as proposed by the national program for CVD risk factors management among the uninsured and poor population with moderate or high CVD risk in Argentina. We conducted a cluster randomized trial in nine primary care clinics (PCCs) in Argentina. Three PCCs were assigned to financial incentives, 3 to framing-text messages (SMS) and 3 to usual care. The incentive scheme included a direct incentive for attending the first clinical visit and the opportunity to participate in a lottery when attending a second clinical visit. The framing-text messages group received messages with a gain-frame format. The main outcome was the proportion of participants who attended the clinical visits. A total of 918 individuals with a risk ≥10% of suffering a CVD event within the next 10 years were recruited to participate in the study. The financial incentive group had a significantly higher percentage of participants who attended the first (59.0% vs 33.9%, p˂ 0.001) and the follow up visit (34.4% and 16.6%, p˂ 0.001) compared to control group. However, the framing-SMS group did not show significant differences compared to the control group. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT03300154.

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Under-detection of HIV/AIDS still burdens many low- and middle-income countries (LMICs). Our randomized trial investigated the effects of financial incentives and a behavioral nudge to induce HIV testing and learning HIV status in Ecuador. In the control group, 12.2% of participants agreed to testing, and 5.3% learned results. A financial incentive paid at testing increased the fraction of participants tested by 50.1 percentage points (95% CI 38.8 to 61.4) and the fraction who learned their status by 8.9 percentage points (95% CI 5.3 to 12.5); the nudge had no effect. The HIV-positive rate was 1.2% in the control group, and incentives prompted a 4.7 percentage point (95% CI 0.5 to 8.9) higher proportion of HIV-positive detection. Incentives also induced earlier testing, suggesting reduced procrastination. This suggests that information with appropriately timed small financial incentives can improve HIV testing and detection of new cases in the general population in LMIC settings.

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O artigo analisa a Lei de Incentivo à Cultura na democratização das artes, como fonte do lazer popular, inseridas nos direitos sociais. Trata-se de pesquisa bibliográfica com leitura descritiva dos incentivos fiscais e sua parceria público-privada aplicadas no fomento do entretenimento às populações periféricas. Em análise multidisciplinar de Cesnik (2012), Coelho (2009), Costa (2020), Nagayama (2020) dialogadas com Almeida (2020), Barbosa (2012), Dumazedier (1975, 1979), Gomes (2014) e Marcellino (1997, 2015), apresenta-se a necessidade de medidas inclusivas a serviço do lazer, que nesse texto se conecta com as artes e a cultura. Percebe-se a isenção tributária manipulada pelo capital e interesses políticos a reclamar reestruturação das instituições públicas atuantes na exigência das políticas públicas de cultura enquanto lazer acessível às camadas de baixa renda, de forma regional e pluralista.

The article analyzes the law of culture incentive on the art democratization, as source of popular leisure, inserted on social rights. It`s about the bibliographic research with descriptive reading of tax incentives and their public ­ private partnership applied in the promotion of entertainment to peripheral populations. In multidisciplinar analysis of Cesnik (2012), Coelho (2009), Costa (2020), Nagayama (2020) dialogued with Almeida (2019, 2020), Barbosa (2012), Bretas (1997), Dumazedier (1975, 2015), Gomes(2014) and Marcelinho (1997, 2015), introduces the needs of inclusive measures for leisure service purpose. Realizes the tax exemption manipulated by capital and political interests to demand restructuring of social movements in the requirement of public politics of leisure as culture accessible to lowincome layers, in a regional and pluralistic way.

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We study the demand-smoothing incentives for private hospitals to perform c-sections. First, we show that a policy change in Chile that increased delivery at private hospitals by reducing the out-of-pocket cost for women with public insurance increased the probability of a c-section by 8.6 percentage points despite private hospitals receiving the same price for a vaginal or cesarean delivery. Second, to understand hospitals' incentives to perform c-sections, we present a model of hospital decisions about the mode of delivery without price incentives. The model predicts that, because c-sections can be scheduled, a higher c-section rate increases total deliveries, compensating the forgone higher margin of vaginal deliveries. Finally, we provide evidence consistent with the demand-smoothing mechanism: hospitals with higher c-section rates are more likely to reschedule deliveries when they expect a high-demand week.

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We experimentally evaluated the effects of in-kind team incentives on health worker performance in El Salvador, with 38 out of 75 community health teams randomly assigned to performance incentives over a 12-month period. All teams received monitoring, performance feedback and recognition for their achievements allowing us to isolate the effect of the incentive. While both treatment and control groups exhibit improvements in performance measures over time, the in-kind incentives generated significant improvements in community outreach, quality of care, timeliness of care, and utilization of maternal and child health services after 12 months. Gains were largest for teams at the bottom and top of the baseline performance distribution. We find no evidence of results being driven by changes in reporting or by shifting away effort from non-contracted outcomes. These results suggest that in-kind team incentives may be a viable alternative to monetary or individual incentives in certain contexts.

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Multidrug-resistant tuberculosis (MDR-TB) is presently a major public health threat. MDR-TB patients face diverse financial and psychosocial difficulties. Researchers conducted in-depth interviews based on interview guides with 42 participants. Data were analyzed using categorization, coding, generation of themes, and thematic memo writing. The key findings were as follows: Out of the 42 patients, 30 (71.4%) were males and 12 (28.6%) were females. All patients received financial stipends for transport and monthly social support. The patients however needed more financial support than they received (suggesting high unmet financial needs). Patients suffered depressive mood before and during treatment but received inadequate mental health/psychosocial care and treatment. Patients developed hearing impairment as a major adverse drug reaction, but the care and treatment they received were inadequate. In conclusion, the programmatic support provided for MDR-TB patients' financial and mental health/psychosocial needs and auditory drug side effects fell short of their need. Programmes for control of MDR-TB should increase budgetary allocations and ramp up mechanisms for provision of mental health/psychosocial support and care/treatment for drug side effects.

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OBJECTIVE: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit. STUDY DESIGN: A randomized, controlled trial compared motivational interviewing plus financial incentives with conventional care on infant urine cotinine at 1 and 4 months' follow-up. Mothers of infants in the neonatal intensive care unit (N = 360) who reported a smoker living in the home were enrolled. Motivational interviewing sessions were delivered in both the hospital and the home. Financial incentives followed session attendance and negative infant cotinine tests postdischarge. RESULTS: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05). CONCLUSIONS: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01726062.

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Introdução: A tuberculose (TB) ganhou expressividade como problema de saúde pública a partir da Revolução Industrial, principalmente devido às más condições de vida e trabalho, e ainda continua como enfermidade negligenciada e de relevância epidemiológica. No Brasil, apresenta índices importantes, com especial destaque para o abandono do tratamento, e acomete particularmente os grupos sociais com menor acesso. Em decorrência, recentemente, a Seguridade Social promove o amparo público para o enfrentamento de dificuldades inerentes à precariedade da vida, com destaque para o Programa Bolsa Família (PBF) e o auxílio-doença. Objetivo: O objetivo geral deste estudo foi analisar a influência de incentivos sociais e de medidas de proteção social no processo de adesão ao tratamento de pacientes com TB no Município de São Paulo. Metodologia: Estudo observacional descritivo-analítico com abordagem quanti-qualitativa, realizado em duas etapas. A TB como um agravo socialmente determinado, a adesão ao tratamento e a proteção social foram os pilares para a interpretação do objeto de estudo. As Supervisões Técnicas de Saúde (STS) do Butantã, Campo Limpo e Penha do Município de São Paulo constituíram o local de estudo que foi realizado com pacientes que realizavam tratamento da TB nas STS indicadas, entre 2015-2017. Na Etapa 1 foram capturados dados secundários disponibilizados pela Coordenação de Vigilância em Saúde e, a Etapa 2, foi realizada por meio de entrevista orientada por questionário semiestruturado. Foram realizadas análises descritivas, associação entre variáveis e os depoimentos foram objeto de análise de discurso. O estudo foi aprovado por Comitê de Ética em Pesquisa. Resultados: Na Etapa 1, 2.225 pessoas compuseram a amostra. Verificou-se associação significativa entre a cura e as seguintes variáveis: idade média de 37,7 anos (p<0,001), raça (p = 0,026), tipo de caso (p<0,001), forma clínica (p<0,001), tipo de tratamento (p<0,001) e algumas comorbidades como HIV/AIDS (p<0,001), alcoolismo (p<0,001) e drogadição (p<0,001). Na Etapa 2, 56 pacientes foram entrevistados; 87,5% receberam cesta básica e 16,1% receberam vale-transporte; 14,3% receberam auxílio-doença e 10,7% o aporte do PBF. Na análise dos depoimentos, emergiram quatro categorias: os benefícios sociais no tratamento da TB, fortalecedores da adesão ao tratamento da TB, barreiras para o tratamento da TB, e representações sobre o tratamento e o processo saúde-doença. Conclusão: Os incentivos e as medidas de proteção social contribuíram para a adesão ao tratamento, salientando-se que devem constituir o alicerce da sociedade, como políticas públicas orientadas à diminuição das desigualdades. O estudo supre uma lacuna para que profissionais de saúde e gestores compreendam a importância da oferta de benefícios sociais, minimamente durante o processo de tratamento.

Introduction: Tuberculosis (TB) has gained much attention as a public health problem since the Industrial Revolution, mainly due to poor living and working conditions and it is still considered a neglected disease of epidemiological relevance. In Brazil, TB presents important indexes with special emphasis on treatment default, and it particularly affects social groups with less access. As result, Social Security promotes public support to face difficulties inherent to the precariousness of life, with emphasis on the Bolsa Família Program (BFP) and paid sick leave. Objective: The main goal of this study was to analyze the influence of social incentives and social protection measures in the process of adherence to the treatment of TB patients in the city of São Paulo, Brazil. Methodology: Observational descriptive-analytical study with a quanti-qualitative approach, carried out in two stages. TB as a socially determined problem, adherence to treatment, and social protection were pillars for the interpretation of the study object. The study was performed at the Technical Health Supervisions (THS) of Butantã, Campo Limpo, and Penha in the city of São Paulo with patients who underwent TB treatment between 2015-2017. In Stage 1, the Health Surveillance Coordination provided the data; and interviews guided by a semi-structured questionnaire were done in Stage 2. Descriptive analyses and variable associations were made, and the speeches were the object of discourse analysis. The study was approved by a Research Ethics Committee. Results: In Stage 1, the sample size was 2,225 people. There was a significant association between cure and the following variables: mean age of 37.7 years (p <0.001), race (p = 0.026), type of case (p <0.001), clinical form (p <0.001), type of treatment (p<0.001) and some comorbidities such as HIV/AIDS (p<0.001), alcoholism (p <0.001) and drug addiction (p<0.001). In Stage 2, 56 patients were interviewed; 87.5% received food baskets, and 16.1% received transportation vouchers; 14.3% received paid sick leave, and 10.7% received the BFP. In the analysis of the speeches, four categories emerged: the social benefits in the treatment of TB, strengthening adherence to the treatment of TB, barriers to the treatment of TB, and representations regarding the treatment and the health-disease process. Conclusion: Incentives and social protection measures contributed to treatment adherence, highlighting that they must constitute the foundation of society as public policies oriented for reducing inequalities. The study fills a gap for health professionals and managers to understand the importance of offering social benefits, at least during the treatment process.

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INTRODUCTION: There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance. However, evidence gaps remain as to what package of incentives will improve their performance in different country contexts. This study aims to evaluate CHW incentive preferences to improve performance and retention which will strengthen CHW programmes and help governments leverage limited resources appropriately. METHODS AND ANALYSIS: A discrete choice experiment (DCE) will be conducted with CHWs in Bangladesh, Haiti, Kenya and Uganda with different levels of maturity of CHWs programmes. This will be carried out in two phases. Phase 1 will involve preliminary qualitative research including focus group discussions (FGDs) and key informant interviews to develop the DCE design which will include attributes relevant to the CHW country settings. Phase 2 will involve a DCE survey with CHWs, presenting them with a series of job choices with varying attribute levels. An orthogonal design will be used to generate the choice sets for the surveys. The surveys will be administered in locally-appropriate languages to at least 150 CHWs from each of the cadres in each country. Conditional and mixed multinomial logit (MMNL) models will be used for the estimation of stated preferences. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Population Council's Institutional Review Board in New York, and appropriate ethics review boards in Kenya, Uganda, Bangladesh and Haiti. The results of the study will be disseminated through in-country dissemination workshops, meetings with country-level stakeholders and policy working groups, print media, online blogs and peer-reviewed journals.

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Objetivo: A obtenção do número adequado de órgãos cadavéricos para transplantes é um item de política pública importante. Modelos econômicos tradicionais supõem que a solução pode ser obtida por incentivos financeiros. Críticos dessa abordagem insistem que o mercado não resolve o problema, mas a intervenção estatal sim. Métodos: Este artigo apresenta o modelo do homo economicus maturus de Frey (1997), cujo principal mérito é mostrar que ambas as críticas estão incorretamente colocadas, pois indivíduos respondem não apenas a incentivos monetários de forma positiva, como demonstram os modelos tradicionais, mas também podem apresentar reações psicológicas adversas. Esse modelo é aplicado ao dilema da doação de órgãos com a inclusão do fator tecnológico, por meio da substituição de órgãos humanos por órgãos não humanos (xenotransplantes). Resultados: O principal resultado do artigo é mostrar como um avanço tecnológico pode melhorar o bem-estar sem alterar o dilema moral dos indivíduos. Conclusões: A extensão do modelo econômico tradicional permite uma análise com novas possibilidades acerca de mudanças tecnológicas e dos dilemas morais que elas podem trazer.

Objective: Obtaining the adequate number of cadaveric organs for transplantation is an important public policy item. Traditional economic models assume that solution can be obtained by financial incentives. Critics of this approach insist that the market does not solve the problem, but state intervention does. Methods: This article presents Frey's (1997) homo economicus maturus model, whose main merit is to show that both critics are incorrectly because individuals respond not only to monetary incentives in a positive way, as traditional models demonstrate, but they can also present adverse psychological reactions. This model is applied to the dilemma of organ donation with the inclusion of the technological factor, through the replacement of human organs by non-human organs (xenotransplantation). Results: The main result of the article is to show how a technological advance can improve well-being without changing the moral dilemma of individuals. Conclusions: The extension of the traditional economic model allows an analysis with new possibilities about technological changes and the moral dilemmas that they can bring.

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OBJECTIVE: To assess the short- and long-term effectiveness of a lottery incentive intervention to promote the purchase of healthy products in school cafeterias. DESIGN: A quasi-experiment in which students' purchases in intervention schools were analysed in a pre-post analysis and also compared with a control school in a difference-in-differences model. A hierarchical linear model assessed the mean number of promoted healthy products purchased daily per participant before (twenty-six weekdays), during (nine weekdays) and after (twenty-eight weekdays) the intervention period. Sex, age and prior purchasing behaviour served as covariates. SETTING: Convenience sample of school cafeterias using a debit-card payment method that allowed for the assessment of students' purchasing behaviour.ParticipantsStudents who used the pre-paid card to buy snacks at the school cafeteria. A total of 352 students (208 in intervention schools and 144 in control school) were included in the final analyses. RESULTS: The incentives programme significantly increased the purchase of promoted healthy products during (v. before) the intervention period in intervention schools (P<0·001), especially among younger children (P=0·036). Among the students who purchased the promoted healthier products during the intervention, there was an increase in total number of purchased products (healthy non-promoted, but also of less healthy products). Sex and past consumption behaviour did not influence the response to incentives in the short term. On average, no long-term effect was observed. CONCLUSIONS: Long-term and negative spillover effects must be taken into consideration for a complete understanding of the effects of incentives on healthier eating.

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