Exploring the potential of a conditional cash transfer intervention to reduce HIV risk among young women in Iringa, Tanzania

Kennedy, Caitlin E.; Brahmbhatt, Heena; Likindikoki, Samuel; Beckham, S. Wilson; Mbwambo, Jessie; Kerrigan, Deanna

doi:10.1080/09540121.2013.824539

Cited by 17 publications

(14 citation statements)

References 14 publications

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“…The project implemented both conditional (school attendance) and unconditional payments ranging from USD1 to USD5, as well as making small payments to parents [13]. In South Africa conditional payments were paid to young people in KwaZulu-Natal province for a range of behaviors, including school attendance [16]; and an ongoing combination HIV prevention intervention is paying cash transfers to female adolescent in Tanzania [17]. However, there has been little investigation of how cash transfers are spent by adolescents; whether concerns about access to cash promoting undesirable behaviors are warranted; and limited discussion of the meaning that access to such money might have for adolescents in impoverished environments.…”

Section: Introductionmentioning

confidence: 99%

Cash transfers for HIV prevention: what do young women spend it on? Mixed methods findings from HPTN 068

et al. 2017

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BackgroundSocial grants have been found to have an impact on health and wellbeing in multiple settings. Who receives the grant, however, has been the subject of discussion with regards to how the money is spent and who benefits from the grant.MethodsUsing survey data from 1214 young women who were in the intervention arm and completed at least one annual visit in the HPTN 068 trial, and qualitative interview data from a subset of 38 participants, we examined spending of a cash transfer provided to young women conditioned on school attendance.ResultsWe found that spending was largely determined and controlled by young women themselves and that the cash transfer was predominately spent on toiletries, clothing and school supplies. In interview data, young women discussed the significant role of cash transfers for adolescent identity, specifically with regard to independence from family and status within the peer network. There were almost no negative consequences from receiving the cash transfer.ConclusionsWe established that providing adolescents access to cash was not reported to be associated with social harms or negative consequences. Rather, spending of the cash facilitated appropriate adolescent developmental behaviours. The findings are encouraging at a time in which there is global interest in addressing the structural drivers of HIV risk, such as poverty, for young women.Trial registrationClinicaltrials.gov NCT01233531 (1 Nov 2010). First participant enrolled 5 March 2011.

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Section: Introductionmentioning

confidence: 99%

Cash transfers for HIV prevention: what do young women spend it on? Mixed methods findings from HPTN 068

et al. 2017

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“…In addition to improving socioeconomic status, these cash payments are believed to reduce sexual risk taking in several ways, including improving individuals’ outlook for the future and increasing preferences for healthier behaviors and activities with delayed returns such as schooling [6, 8]. Cash may also address the causal path linking poverty to HIV infection by mitigating the need for transactional sex and sex with older partners and allow individuals to give more weight to long-term consequences of risk behaviors [32]. …”

Section: Preventionmentioning

confidence: 99%

Financial incentives to improve progression through the HIV treatment cascade

Bassett

Wilson

Taaffe

et al. 2015

Current Opinion in HIV and AIDS

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Purpose of review We reviewed recent literature on conditional and unconditional financial incentives for their impact on improving movement through the HIV care cascade and HIV prevention. Recent findings Concepts from behavioral economics may help improve engagement in HIV care by addressing upstream structural risk factors for HIV, such as poverty, or by providing conditional rewards for immediate, measurable outcomes related to HIV care. Incentives have been shown to increase uptake of HIV testing. Yet, few studies to date focus on linkage to care: one large US-based randomized trial failed to show an effect of incentives; a smaller trial showed improved linkage to care among drug users, but no difference in virologic suppression. Several small US-based studies have shown an impact of financial incentives on antiretroviral therapy adherence, but without durability beyond the incentive period. HIV prevention has the most robust evidence for decreasing HIV risk-taking behavior among adolescents and may serve as a model for research on the care cascade. Summary Financial incentives show promise for improving engagement in HIV testing, care, and prevention. Understanding the durability, scalability, ease of implementation, and cost-effectiveness of these different approaches will be critical for maximizing the impact of incentives in curtailing the HIV epidemic.

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“…In the field of HIV, recent studies using large conditional rewards to prevent HIV [17–19] and link HIV-infected individuals to HIV care have not delivered the desired results [20], and novel, more effective ways to provide incentives are needed.…”

Section: Introductionmentioning

confidence: 99%

Behavioral economic incentives to improve adherence to antiretroviral medication

Linnemayr

Stecher

Mukasa

2017

Aids

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Objective Fixed incentives have been largely unsuccessful in improving adherence to antiretroviral medication. Therefore, we evaluate whether small incentives based on behavioral economic theory can increase adherence to antiretroviral medication among treatment-mature adults in Kampala, Uganda. Design A randomized control trial design tests whether providing small incentives based on either attending timely clinic visits (intervention group 1) or achieving high medication adherence (intervention group 2) can increase antiretroviral adherence. Antiretroviral adherence is measured by medical event monitoring system (MEMS) caps. Methods Overall, 155 HIV-infected men and women age 19–78 were randomized into one of two intervention groups and received small prizes of US $1.50 awarded through a drawing conditional on either attending scheduled clinic appointments or achieving at least 90% antiretroviral adherence. The control group received the usual standard of care. Results Preliminary results based on pooling the intervention groups showed individuals receiving incentives were 23.7 percentage points more likely to achieve 90% antiretroviral adherence compared with the control group [95% confidence interval (CI), 6.7–40.7%]. Specifically, 63.3% (95% CI, 52.9–72.8%) of participants in the pooled intervention groups maintained at least 90% mean adherence during the first 9 months of the intervention, compared with 39.6% (95% CI, 25.8–54.7%) in the control group. Conclusion Small prize incentives resulted in a statistically significant increase in antiretroviral adherence. Although more traditional fixed incentives have not produced the desired results, these findings suggest that small incentives based on behavioral economic theory may be more effective in motivating long-term adherence among treatment-mature adults.

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Exploring the potential of a conditional cash transfer intervention to reduce HIV risk among young women in Iringa, Tanzania

Cited by 17 publications

References 14 publications

Cash transfers for HIV prevention: what do young women spend it on? Mixed methods findings from HPTN 068

Cash transfers for HIV prevention: what do young women spend it on? Mixed methods findings from HPTN 068

Financial incentives to improve progression through the HIV treatment cascade

Behavioral economic incentives to improve adherence to antiretroviral medication

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