The heterogeneous effect of short-term transfers for improving ART adherence among HIV-infected Tanzanian adults

Bibliographic Data

ID19441907
AuthorsJillian L Kadota (0000-0003-4568-8681, Division of Epidemiology, University of California, Berkeley, CA, USA, corresponding author), Carolyn A Fahey (0000-0001-9865-2397, Division of Epidemiology, University of California, Berkeley, CA, USA), Prosper Njau (0000-0002-6351-9489, Ministry of Health, Community Development, Gender, Elderly and Children), Prosper F Njau, Ntuli Kapologwe (0000-0003-0900-2937, Ministry of Health, Community Development, Gender, Elderly and Children), Nancy Padian (0000-0003-1046-2287, University of California, Berkeley), Nancy S Padian, William H Dow (0000-0002-4080-1668, University of California, Berkeley), Sandra I Mccoy (0000-0002-4764-9195, University of California, Berkeley)
Year2018
Volume30
Issuesup3
Pages18-26
Publication date2018-07-25
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAIDS Care (JOURNAL)
Journal identifiersISSN: 0954-0121 • E-ISSN: 1360-0451
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/09540121.2018.1476666
PMID30793875
OpenAlexW2813827387
LanguageEN
Citations received2
References cited31

A recently concluded randomized study in Tanzania found that short-term conditional cash and food transfers significantly improved HIV-infected patients’ possession of antiretroviral therapy (ART) and reduced patient loss to follow-up (LTFU) (McCoy, S. I., Njau, P. F., Fahey, C., Kapologwe, N., Kadiyala, S., Jewell, N. P., & Padian, N. S. (2017). Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania. AIDS, 31(6), 815–825. doi:10.1097/QAD.0000000000001406 ). We examined whether these transfers had differential effects within population subgroups. In the parent study, 805 individuals were randomized to one of three study arms: standard-of-care (SOC) HIV services, food assistance, or cash transfer. We compared achievement of the medication possession ratio (MPR) ≥ 95% at 6 and 12 months and patient LTFU at 12 months between those receiving the SOC and those receiving food or cash (combined). Using a threshold value of p < 0.20 to signal potential effect measure modifiers (EMM), we compared intervention effects, expressed as risk differences (RD), within subgroups characterized by: sex, age, wealth, and time elapsed between HIV diagnosis and ART initiation. Short-term transfers improved 6 and 12-month MPR ≥ 95% and reduced 12-month LTFU in most subgroups. Study results revealed wealth and time elapsed between HIV diagnosis and ART initiation as potential EMMs, with greater effects for 6-month MPR ≥ 95% in the poorest patients (RD: 32, 95% CI: (9, 55)) compared to those wealthier (RD: 16, 95% CI: (5, 27); p = 0.18) and in newly diagnosed individuals (<90 days elapsed since diagnosis) (RD: 25, 95% CI: (13, 36)) compared to those with ≥90 days (RD: 0.3, 95% CI (−17, 18); p = 0.02), patterns which were sustained at 12 months. Results suggest that food and cash transfers may have stronger beneficial effects on ART adherence in the poorest patients. We also provide preliminary data suggesting that targeting interventions at patients more recently diagnosed with HIV may be worthwhile. Larger and longer-term assessments of transfer programs for the improvement of ART adherence and their potential heterogeneity by sub-population are warranted

Antiretroviral therapy · Cash · Cash transfers · Conditional cash transfer · Environmental health · Family medicine · Population · Randomized controlled trial · Tanzania · Viral load · Adolescent Sexual and Reproductive Health · Demography · HIV/AIDS Research and Interventions · Medicine · Poverty, Education, and Child Welfare · Finance · Internal Medicine · Pediatrics