Incentivising safe sex

A randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania

Datos Bibliográficos

ID23367698
AutoresDamien De Walque (0000-0003-1592-7602, World Bank Group, autor de correspondencia), William H Dow (0000-0002-4080-1668, University of California, Berkeley), Rose Nathan (0000-0003-3977-5156, Ifakara Health Institute), Ramadhani Abdul (0000-0003-3591-8279, Ifakara Health Institute), Faraji Abilahi (Ifakara Health Institute), Erick Gong (Middlebury College), Zachary Isdahl (0000-0002-4933-3880, University of California, Berkeley), Julian Jamison (0000-0003-2671-1153, Federal Reserve Bank of Boston), Boniphace S Jullu (Ifakara Health Institute), Boniphace Jullu, Suneeta Krishnan (RTI International), Albert Majura (Ifakara Health Institute), Edward Miguel (0000-0001-6927-709X, University of California, Berkeley), Jeanne Moncada (University of California, San Francisco), Sally Mtenga (0000-0001-6100-7562, Ifakara Health Institute), Mathew Alexander Mwanyangala (Ifakara Health Institute), Laura J Packel (0000-0002-8186-5246, University of California, San Francisco), Laura Packel, Julius Schachter (University of California, San Francisco), Kizito Shirima (Ifakara Health Institute), Carol A Medlin, Carol Medlin (Gates Foundation)
Año2012
Volumen2
Número1
Páginase000747
Fecha de publicación2012-01-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Open (JOURNAL)
Identificadores de la revistaISSN: 2044-6055 • E-ISSN: 2044-6055
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjopen-2011-000747
PMID22318666
PMCIDPMC3330254
OpenAlexW2104015227
IdiomaEN
Citas recibidas77
Referencias citadas16

OBJECTIVE: The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex. DESIGN: An unblinded, individually randomised and controlled trial. SETTING: 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania. PARTICIPANTS: The authors enrolled 2399 participants, aged 18-30 years, including adult spouses. INTERVENTIONS: 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. MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION NUMBER: NCT00922038 ClinicalTrials.gov.

Conditional cash transfer · Environmental health · Family medicine · Human immunodeficiency virus (HIV) · Men who have sex with men · Pathology · Public health · Randomized controlled trial · Syphilis · Tanzania · Adolescent Sexual and Reproductive Health · HIV/AIDS Research and Interventions · Medicine · Sex work and related issues · Surgery