Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial
Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial
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DOI：
10.1016/s0140-6736(11)61709-1
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发表时间：
2012-04-07
期刊：
影响因子：
168.9
通讯作者：
Oezler, Berk
中科院分区：
文献类型：
--
作者：
Baird, Sarah J.;Garfein, Richard S.;Oezler, Berk
缺乏教育和在经济上依赖男性往往被认为是妇女感染艾滋病毒的重要危险因素。我们评估了现金转移计划在降低年轻女性性传播感染风险方面的有效性。方法在该整群随机试验中，从马拉维Zomba地区的176个抽样区招募13-22岁的未婚妇女，按抽样区（1:1）随机分配计算机生成的随机数，接受现金支付（干预组）或不接受现金支付（对照组）。干预枚举区域进一步用计算机生成的随机数随机分配到有条件组（必须上学才能获得付款）和无条件组（没有获得付款的要求）。两个干预组的参与者通过抽签随机分配，每月收到1美元到5美元不等的款项，而他们的父母则被独立分配给计算机生成的随机数，每月收到4美元到10美元。在基线和12个月时进行行为风险评估；18个月时进行血清学检测。参与者不知道治疗状态，但做血清学测试的咨询师知道。主要结局是18个月时HIV和单纯疱疹病毒2 （HSV-2）的患病率，并通过意向治疗分析进行评估。该试验已注册，编号NCT01333826。结果：88个抽样区接受干预，88个作为对照。对于1289名在基线时入学并具有完整访谈和生物标志物数据的个体，联合干预组在18个月随访时的加权HIV患病率为1.2%（490名参与者中有7名），而对照组为3.0%（799名参与者中有17名）（调整优势比[OR] 0.36, 95% CI 0.14-0.91）；加权HSV-2患病率为0.7%（488名参与者中有5名）对3.0%（796名参与者中有27名；调整后OR为0.24,0.09-0.65）。在干预组中，我们注意到有条件干预组与无条件干预组在加权HIV患病率（3/235 [1%]vs 4/255[2%]）或加权HSV-2患病率（4/233 [1%]vs 1/255[2%]）方面没有差异。
Background Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women.Methods In this cluster randomised trial, never-married women aged 13-22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and randomly assigned with computer-generated random numbers by enumeration area (1:1) to receive cash payments (intervention group) or nothing (control group). Intervention enumeration areas were further randomly assigned with computer-generated random numbers to conditional (school attendance required to receive payment) and unconditional (no requirements to receive payment) groups. Participants in both intervention groups were randomly assigned by a lottery to receive monthly payments ranging from US$1 to $5, while their parents were independently assigned with computer-generated random numbers to receive $4-10. Behavioural risk assessments were done at baseline and 12 months; serology was tested at 18 months. Participants were not masked to treatment status but counsellors doing the serologic testing were. The primary outcomes were prevalence of HIV and herpes simplex virus 2 (HSV-2) at 18 months and were assessed by intention-to-treat analyses. The trial is registered, number NCT01333826.Findings 88 enumeration areas were assigned to receive the intervention and 88 as controls. For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data, weighted HIV prevalence at 18 month follow-up was 1.2% (seven of 490 participants) in the combined intervention group versus 3.0% (17 of 799 participants) in the control group (adjusted odds ratio [OR] 0.36, 95% CI 0.14-0.91); weighted HSV-2 prevalence was 0.7% (five of 488 participants) versus 3.0% (27 of 796 participants; adjusted OR 0.24, 0.09-0.65). In the intervention group, we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence (3/235 [1%] vs 4/255 [2%]) or weighted HSV-2 prevalence (4/233 [1%] vs 1/255 [