TY - JOUR
T1 - Unconditional cash transfers for clinical and economic outcomes among HIV-Affected Ugandan households
AU - Mills, Edward J.
AU - Adhvaryu, Achyuta
AU - Jakiela, Pamela
AU - Birungi, Josephine
AU - Okoboi, Stephen
AU - Chimulwa, Teddy Nabwire W.
AU - Wanganisi, Jonathan
AU - Achilla, Tina
AU - Popoff, Evan
AU - Golchi, Shirin
AU - Karlan, Dean
N1 - Publisher Copyright:
© 2018 Lippincott Williams and Wilkins. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Background: HIV infection has profound clinical and economic costs at the household level. This is particularly important in low-income settings, where access to additional sources of income or loans may be limited. While several microfinance interventions have been proposed, unconditional cash grants, a strategy to allow participants to choose how to use finances that may improve household security and health, has not previously been evaluated. Methods: We examined the effect of an unconditional cash transfer to HIV-infected individuals using a 22 factorial randomized trial in two rural districts in Uganda. Our primary outcomes were changes in CD4 cell count, sexual behaviors, and adherence to ART. Secondary outcomes were changes in household food security and adult mental health. We applied a Bayesian approach for our primary analysis. Results: We randomized 2170 patients as participants, with 1081 receiving a cash grant. We found no important intervention effects on CD4 T-cell counts between groups [mean difference 35.48, 95% credible interval (CrI) 59.9 to 1131.6], food security [odds ratio (OR) 1.22, 95% CrI: 0.47 to 3.02], medication adherence (OR 3.15, 95% CrI: 0.58 to 18.15), or sexual behavior (OR 0.45 95% CrI: 0.12 to 1.55), or health expenditure in the previous 3 weeks (mean difference $2.65, 95% CrI: 9.30 to 15.69). In secondary analysis, we detected an effect of mental planning on CD4 cell count change between groups (104.2 cells, 9% CrI: 5.99 to 202.16). We did not have data on viral load outcomes. Conclusion: Although all outcomes were associated with favorable point estimates, our trial did not demonstrate important effects of unconditional cash grants on health outcomes of HIV-positive patients receiving treatment.
AB - Background: HIV infection has profound clinical and economic costs at the household level. This is particularly important in low-income settings, where access to additional sources of income or loans may be limited. While several microfinance interventions have been proposed, unconditional cash grants, a strategy to allow participants to choose how to use finances that may improve household security and health, has not previously been evaluated. Methods: We examined the effect of an unconditional cash transfer to HIV-infected individuals using a 22 factorial randomized trial in two rural districts in Uganda. Our primary outcomes were changes in CD4 cell count, sexual behaviors, and adherence to ART. Secondary outcomes were changes in household food security and adult mental health. We applied a Bayesian approach for our primary analysis. Results: We randomized 2170 patients as participants, with 1081 receiving a cash grant. We found no important intervention effects on CD4 T-cell counts between groups [mean difference 35.48, 95% credible interval (CrI) 59.9 to 1131.6], food security [odds ratio (OR) 1.22, 95% CrI: 0.47 to 3.02], medication adherence (OR 3.15, 95% CrI: 0.58 to 18.15), or sexual behavior (OR 0.45 95% CrI: 0.12 to 1.55), or health expenditure in the previous 3 weeks (mean difference $2.65, 95% CrI: 9.30 to 15.69). In secondary analysis, we detected an effect of mental planning on CD4 cell count change between groups (104.2 cells, 9% CrI: 5.99 to 202.16). We did not have data on viral load outcomes. Conclusion: Although all outcomes were associated with favorable point estimates, our trial did not demonstrate important effects of unconditional cash grants on health outcomes of HIV-positive patients receiving treatment.
KW - HIV
KW - Microfinance
KW - Unconditional cash grant
KW - factorial randomized trial
UR - http://www.scopus.com/inward/record.url?scp=85065147466&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065147466&partnerID=8YFLogxK
U2 - 10.1097/QAD.0000000000001899
DO - 10.1097/QAD.0000000000001899
M3 - Article
C2 - 29847330
AN - SCOPUS:85065147466
SN - 0269-9370
VL - 32
SP - 2023
EP - 2031
JO - AIDS
JF - AIDS
IS - 14
ER -