Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial.
Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial.
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DOI：
10.2196/30372
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发表时间：
2022-09-19
影响因子：
8.5
通讯作者：
Wambura, Mwita
中科院分区：
文献类型：
--
作者：
Kuringe, Evodius;Christensen, Alice;Materu, Jacqueline;Drake, Mary;Majani, Esther;Casalini, Caterina;Mjungu, Deusdedit;Mbita, Gaspar;Kalage, Esther;Komba, Albert;Nyato, Daniel;Nnko, Soori;Shao, Amani;Changalucha, John;Wambura, Mwita
关键词：
贫穷和社会不平等加剧了撒哈拉以南非洲少女和青年妇女感染艾滋病毒的风险。现金转移可影响健康的结构性决定因素，从而降低艾滋病毒风险。这项研究评估了现金转移支付与艾滋病毒预防（CHP）联合干预措施沿着在减少坦桑尼亚AGYW危险性行为方面的有效性。单纯疱疹病毒2型（HSV-2）感染的发生率被用作性风险行为的代表。在坦桑尼亚Shinyanga地区的3个阶层（城市，农村高风险和农村低风险人群）的15个配对社区（1：1干预与对照）中进行了一项群集随机对照试验。目标人群是年龄在15-23岁之间的校外青少年，他们已经完成了10个小时的社会和行为改变交流课程。符合条件的社区被随机分配接受卫生保健沿着现金转移每季度（干预组）或单独卫生保健干预（对照组），没有掩盖。研究招募和基线调查于2017年10月30日至2017年12月1日进行。参与者在基线和基线调查后6个月、12个月和18个月的随访期间完成了音频计算机辅助自我访谈、HIV咨询和检测以及HSV-2检测。拟合了一个考克斯比例风险模型，该模型具有针对匹配对和其他基线不平衡调整的聚类水平（共享脆弱性）的随机效应，以评估现金转移对HSV-2感染发生率（主要结局）的影响。次要结果包括随访时的艾滋病毒感染率、自我报告的代际性行为和自我报告的有偿性行为。在每次研究访视时测量所有次要结局。在入组试验的3026名AGYW（干预组1482名，对照组1544名）中，2720名AGYW（干预组1373名，对照组1347名）被纳入最终分析。总体而言，在校正分析中，研究组之间所有随访时间点的HSV-2发生率均无显著差异（风险比0.96，95% CI 0.67-1.38; P= 0.83）。然而，接受现金转移干预的农村低风险人群中HSV-2的发病率显著降低（风险比0.45，95%CI 0.29-0.71; P= 0.001），调整了潜在的混杂因素。尽管该试验显示，现金转移干预对AGYW总体HSV-2发病率没有显著影响，但干预显著降低了农村低风险社区AGYW的HSV-2发病率。城市和农村高风险社区贫穷程度较低和拥有更多资产等因素可能削弱了现金转移的影响。ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243
Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. 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 after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243
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DOI：
10.2147/ijwh.s142232
发表时间：
2017
期刊：
International journal of women's health
影响因子：
--
作者：
Butts SA;Parmley LE;Alcaide ML;Rodriguez VJ;Kayukwa A;Chitalu N;Weiss SM;Jones DL
通讯作者：
Jones DL
影响因子：
3.7
作者：
Kapiga SH;Ewings FM;Ao T;Chilongani J;Mongi A;Baisley K;Francis S;Andreasen A;Hashim R;Watson-Jones D;Changalucha J;Hayes R
通讯作者：
Hayes R
影响因子：
2.9
作者：
de Walque D;Dow WH;Nathan R;Abdul R;Abilahi F;Gong E;Isdahl Z;Jamison J;Jullu B;Krishnan S;Majura A;Miguel E;Moncada J;Mtenga S;Mwanyangala MA;Packel L;Schachter J;Shirima K;Medlin CA
通讯作者：
Medlin CA
影响因子：
3.7
作者：
Estes, Larissa J.;Lloyd, Linda E.;Glick, Nancy
通讯作者：
Glick, Nancy
影响因子：
3.7
作者：
Gottert A;Pulerwitz J;Siu G;Katahoire A;Okal J;Ayebare F;Jani N;Keilig P;Mathur S
通讯作者：
Mathur S