Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: May 12, 2021
Open Peer Review Period: May 11, 2021 - May 25, 2021
Date Accepted: Aug 2, 2022
(closed for review but you can still tweet)
Cash transfer to adolescent girls and young women to reduce risky sexual behaviour: A cluster randomised controlled trial in Tanzania
ABSTRACT
Background:
Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers (CT) can influence structural factors, therefore reducing HIV risk.
Objective:
This study assessed the effectiveness of CT, delivered alongside combination HIV prevention (CHP) interventions, in reducing AGYW risky sexual behaviour in Tanzania. Herpes Simplex Virus (HSV)-2 incidence was used as a proxy for sexual risk behaviour.
Methods:
A cluster-randomised controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across3 strata (urban, rural high-risk, rural low-risk) of Shinyanga Region, Tanzania. The target population for the trial was out-of-school AGYW aged 15-23 years who had completed 10 hours of social and behaviour change communication. Eligible participants were randomised to receive CHP plus CT quarterly (intervention) or solely CHP interventions (control) with no masking. Participants completed an Audio Computer-Assisted Self-Interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12 and 18 months. The proportional hazards model was used in an intention-to-treat analysis for incidence of HSV-2, the primary outcome.
Results:
Of the 3,026 AGYW enrolled in the trial (1,482 intervention; 1,544 control), 2,720 (1,373 intervention; 1,347 control) were used in the final analysis. Overall HSV-2 incidence was not significantly different at all follow-up points between study arms in the adjusted analysis (HR=0.96; 95% CI: 0.67-1.38). However, HSV-2 incidence was significantly lower in the intervention rural low-risk sites (HR 0.45, 95% CI 0.29-0.71) adjusted for potential confounders.
Conclusions:
Although the trial showed no significant impact on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural, low-risk communities. Presence of factors such as less poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of CT. Clinical Trial: ClinicalTrials.gov NCT03597243
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