Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania.
Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania.
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DOI：
10.1136/bmjopen-2011-000747
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Medlin CA
中科院分区：
文献类型：
--
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
作者评估了使用有条件现金转移作为艾滋病毒和性传播感染预防战略，以激励安全性行为。一项非盲、个体随机和对照试验。坦桑尼亚西南部农村地区Ifakara卫生和人口监测系统Kilombero/Ulanga区的10个村庄。作者招募了2399名参与者，年龄在18-30岁之间，包括成年配偶。 参与者被随机分配到对照组（n=1124）或两个干预组之一：低价值有条件现金转移（每轮测试合格10美元，n=660）和高价值有条件现金转移（每轮测试合格20美元，n=615）。作者在12个月内每4个月对参与者进行一次检测，以确定是否存在常见性传播感染。 在干预组，有条件的现金转移支付与性传播感染检测结果阴性挂钩。任何性传播感染检测呈阳性的人都得到免费治疗，所有人都得到咨询。主要研究终点是每4个月检测并报告受试者的4种性传播感染的合并患病率：沙眼衣原体、淋病奈瑟菌、阴道毛滴虫和生殖支原体。 作者还在基线和第12个月检测了HIV、单纯疱疹病毒2和梅毒。在12个月期间结束时，每4个月检测和报告一次的四种性传播感染中任何一种的合并流行率 （沙眼衣原体、淋病奈瑟菌、迷走支原体和生殖支原体），与对照组相比，高价值有条件现金转移部门的未调整RR为0.80（95% CI 0.54至1.06），调整后的RR为0.73（95% CI 0.47至0.99）。与低价值有条件现金转移组相比，高价值有条件现金转移组的未调整RR为0.76（95% CI 0.49至1.03），调整后RR为0.69（95% CI 0.45至0.92）。未报告伤害。用于鼓励更安全性行为的有条件现金转移是预防艾滋病毒和性传播感染的一个潜在的有前途的新工具。更多更大规模的研究将有助于澄清效应大小，校准激励措施的大小，并确定干预措施是否能够以成本效益的方式进行。NCT 00922038 ClinicalTrials.gov.现有的预防战略对艾滋病毒/艾滋病流行的轨迹影响有限。有条件的现金转移支付已在各种环境中成功地用于促进有利于参与者的活动，如上学或儿童健康检查。这项试验询问是否可以使用有条件的现金转移来防止人们从事对自己和他人有害的活动，例如不安全的性行为。我们设计并评估了一种新的干预措施，该措施在短时间内反复测试危险的性行为，以一组可治愈的性传播感染（STI）测试阴性为条件，通过现金转移奖励来加强对安全行为的学习。12个月后，调整后模型的结果显示，在有资格获得20美元付款的群体中，每4个月通过核酸扩增检测检测的4种可治愈性传播感染的合并点患病率显着降低，但在接受10美元付款的群体中没有发现这种降低。 研究结果表明，用于鼓励安全性行为的有条件现金转移是预防艾滋病毒和性传播感染的一个潜在的有前途的新工具。更多更大规模的研究将有助于澄清效应大小，校准激励措施的大小，并确定干预措施是否能够以成本效益的方式进行。本文报告了一种新的艾滋病毒和性传播感染预防方法的结果。我们的研究方法是严格的，其结果可能会推动关于艾滋病毒/性传播感染预防的经济方法的全球对话。我们的主要结果指标是一年中通过核酸扩增检测反复检测的四种性传播感染的合并点患病率，这些性传播感染与危险的性活动有着无可争议的联系。然而，这些生物学结果不能用来推断寻求性传播感染治疗的行为相对于其他行为改变的相对重要性，例如增加避孕套的使用或降低伴侣的风险。本研究报告的结果仅限于12个月的试验，无法解决科技创新成果改善在较长时期内的可持续性问题，特别是在有条件现金转移支付停止之后。
The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex. An unblinded, individually randomised and controlled trial. 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania. The authors enrolled 2399 participants, aged 18–30 years, including adult spouses. Participants were randomly assigned to either a control arm (n=1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n=660) and high-value conditional cash transfer (eligible for $20 per testing round, n=615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling. The primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12. At the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high-value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported. Conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively. NCT00922038 ClinicalTrials.gov. Existing prevention strategies have had a limited impact on the trajectory of the HIV/AIDS epidemic. Conditional cash transfers have been used successfully in a variety of settings to promote activities that are beneficial to the participants, such as school participation or health check-ups for children. This trial asks whether conditional cash transfers can be used to prevent people from engaging in activities that are harmful to themselves and others, such as unsafe sex. We designed and evaluated a novel intervention that tests for risky sexual behaviour repeatedly over short time intervals, reinforcing learning about safer behaviour with cash transfer incentives conditional on testing negative for a set of curable sexually transmitted infections (STIs). After 12 months, the results from the adjusted model showed a significant reduction in the combined point prevalence of the four curable STIs tested every 4 months by nucleic acid amplification tests in the group that was eligible for the $20 payments, but no such reduction was found for the group receiving the $10 payments. The results suggest that conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and STIs prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively. This paper reports the results of a novel approach for HIV and STI prevention. Our study methodology is rigorous, and the results are likely to advance a global conversation about economic approaches to HIV/STI prevention. Our main outcome measure is the combined point prevalence of four STIs repeatedly tested by nucleic acid amplification tests over the course of the year and which have been incontrovertibly linked to risky sexual activity. These biological outcomes, however, cannot be used to infer the relative importance of STI treatment seeking behaviour versus other behaviour changes, such as increased condom use or reducing riskiness of partners. The results reported in this study are limited to a 12-month experiment and cannot address the sustainability of improvements in STI outcomes over a longer period, particularly after the conditional cash transfers have been discontinued.
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影响因子：
3.8
作者：
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通讯作者：
Weiss, Helen Anne
DOI：
10.1257/aer.98.5.1829
发表时间：
2008-12-01
期刊：
The American economic review
影响因子：
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通讯作者：
Thornton RL
DOI：
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影响因子：
3.6
作者：
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影响因子：
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作者：
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通讯作者：
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