SidaSubSaharaV1, Main, Exploration, bibRecordById, PMC:3330254

Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania

Identifieur interne : 003321 ( Main/Exploration ); précédent : 003320; suivant : 003322

Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania

Auteurs : Damien De Walque [États-Unis] ; William H. Dow [États-Unis] ; Rose Nathan [Tanzanie] ; Ramadhani Abdul [Tanzanie] ; Faraji Abilahi [Tanzanie] ; Erick Gong [États-Unis] ; Zachary Isdahl [États-Unis] ; Julian Jamison [États-Unis] ; Boniphace Jullu [Tanzanie] ; Suneeta Krishnan [États-Unis] ; Albert Majura [Tanzanie] ; Edward Miguel [États-Unis] ; Jeanne Moncada [États-Unis] ; Sally Mtenga [Tanzanie] ; Mathew Alexander Mwanyangala [Tanzanie] ; Laura Packel [États-Unis] ; Julius Schachter [États-Unis] ; Kizito Shirima [Tanzanie] ; Carol A. Medlin [États-Unis]

Source :

BMJ Open [ 2044-6055 ] ; 2012.

RBID : PMC:3330254

Abstract

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.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3330254

DOI: 10.1136/bmjopen-2011-000747
PubMed: 22318666
PubMed Central: 3330254

Affiliations:

Le document en format XML

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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania</title>
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<author><name sortKey="Abilahi, Faraji" sort="Abilahi, Faraji" uniqKey="Abilahi F" first="Faraji" last="Abilahi">Faraji Abilahi</name>
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<author><name sortKey="Gong, Erick" sort="Gong, Erick" uniqKey="Gong E" first="Erick" last="Gong">Erick Gong</name>
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<author><name sortKey="Isdahl, Zachary" sort="Isdahl, Zachary" uniqKey="Isdahl Z" first="Zachary" last="Isdahl">Zachary Isdahl</name>
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<author><name sortKey="Jullu, Boniphace" sort="Jullu, Boniphace" uniqKey="Jullu B" first="Boniphace" last="Jullu">Boniphace Jullu</name>
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<author><name sortKey="Majura, Albert" sort="Majura, Albert" uniqKey="Majura A" first="Albert" last="Majura">Albert Majura</name>
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<author><name sortKey="Miguel, Edward" sort="Miguel, Edward" uniqKey="Miguel E" first="Edward" last="Miguel">Edward Miguel</name>
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<author><name sortKey="Moncada, Jeanne" sort="Moncada, Jeanne" uniqKey="Moncada J" first="Jeanne" last="Moncada">Jeanne Moncada</name>
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<author><name sortKey="Mtenga, Sally" sort="Mtenga, Sally" uniqKey="Mtenga S" first="Sally" last="Mtenga">Sally Mtenga</name>
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<author><name sortKey="Mwanyangala, Mathew Alexander" sort="Mwanyangala, Mathew Alexander" uniqKey="Mwanyangala M" first="Mathew Alexander" last="Mwanyangala">Mathew Alexander Mwanyangala</name>
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<author><name sortKey="Packel, Laura" sort="Packel, Laura" uniqKey="Packel L" first="Laura" last="Packel">Laura Packel</name>
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<country xml:lang="fr">États-Unis</country>
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</placeName>
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<author><name sortKey="Schachter, Julius" sort="Schachter, Julius" uniqKey="Schachter J" first="Julius" last="Schachter">Julius Schachter</name>
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<author><name sortKey="Shirima, Kizito" sort="Shirima, Kizito" uniqKey="Shirima K" first="Kizito" last="Shirima">Kizito Shirima</name>
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<country xml:lang="fr">Tanzanie</country>
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<author><name sortKey="Medlin, Carol A" sort="Medlin, Carol A" uniqKey="Medlin C" first="Carol A" last="Medlin">Carol A. Medlin</name>
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<country xml:lang="fr">États-Unis</country>
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<front><div type="abstract" xml:lang="en"><sec><title>Objective</title>
<p>The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivise safe sex.</p>
</sec>
<sec><title>Design</title>
<p>An unblinded, individually randomised and controlled trial.</p>
</sec>
<sec><title>Setting</title>
<p>10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania.</p>
</sec>
<sec><title>Participants</title>
<p>The authors enrolled 2399 participants, aged 18–30 years, including adult spouses.</p>
</sec>
<sec><title>Interventions</title>
<p>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.</p>
</sec>
<sec><title>Main outcome measures</title>
<p>The primary study end point was combined prevalence of the four sexually transmitted infections, which were tested and reported to subjects every 4 months: <italic>Chlamydia trachomatis</italic>
, <italic>Neisseria gonorrhoeae</italic>
, <italic>Trichomonas vaginalis</italic>
 and <italic>Mycoplasma genitalium</italic>
. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12.</p>
</sec>
<sec><title>Results</title>
<p>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 (<italic>C trachomatis</italic>
, <italic>N gonorrhoeae</italic>
, <italic>T vaginalis</italic>
 and <italic>M genitalium</italic>
), 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.</p>
</sec>
<sec><title>Conclusions</title>
<p>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.</p>
</sec>
<sec><title>Trial registration number</title>
<p>NCT00922038 <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov">ClinicalTrials.gov</ext-link>
.</p>
</sec>
</div>
</front>
<back><div1 type="bibliography"><listBibl><biblStruct></biblStruct>
<biblStruct><analytic><author><name sortKey="Bertrand, Jr" uniqKey="Bertrand J">JR Bertrand</name>
</author>
<author><name sortKey="O Reilly, K" uniqKey="O Reilly K">K O'Reilly</name>
</author>
<author><name sortKey="Denison, J" uniqKey="Denison J">J Denison</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Napierala Mavedzenge, Sm" uniqKey="Napierala Mavedzenge S">SM Napierala Mavedzenge</name>
</author>
<author><name sortKey="Doyle, Am" uniqKey="Doyle A">AM Doyle</name>
</author>
<author><name sortKey="Ross, Da" uniqKey="Ross D">DA Ross</name>
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</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Fiszbein, A" uniqKey="Fiszbein A">A Fiszbein</name>
</author>
<author><name sortKey="Schady, N" uniqKey="Schady N">N Schady</name>
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</biblStruct>
<biblStruct><analytic><author><name sortKey="Gertler, P" uniqKey="Gertler P">P Gertler</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Petry, Nm" uniqKey="Petry N">NM Petry</name>
</author>
<author><name sortKey="Petrakis, I" uniqKey="Petrakis I">I Petrakis</name>
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<author><name sortKey="Trevisan, L" uniqKey="Trevisan L">L Trevisan</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Gertler, P" uniqKey="Gertler P">P Gertler</name>
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<author><name sortKey="Shah, M" uniqKey="Shah M">M Shah</name>
</author>
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</author>
</analytic>
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</author>
<author><name sortKey="Yeh, E" uniqKey="Yeh E">E Yeh</name>
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</analytic>
</biblStruct>
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</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Thornton, R" uniqKey="Thornton R">R Thornton</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Kohler, Hp" uniqKey="Kohler H">HP Kohler</name>
</author>
<author><name sortKey="Thornton, R" uniqKey="Thornton R">R Thornton</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Schellenberg, Ja" uniqKey="Schellenberg J">JA Schellenberg</name>
</author>
<author><name sortKey="Mukasa, O" uniqKey="Mukasa O">O Mukasa</name>
</author>
<author><name sortKey="Abdulla, S" uniqKey="Abdulla S">S Abdulla</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Napierala Mavedzenge, S" uniqKey="Napierala Mavedzenge S">S Napierala Mavedzenge</name>
</author>
<author><name sortKey="Weiss, Ha" uniqKey="Weiss H">HA Weiss</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Niccolai, Lm" uniqKey="Niccolai L">LM Niccolai</name>
</author>
<author><name sortKey="Rowhani Rahbar, A" uniqKey="Rowhani Rahbar A">A Rowhani-Rahbar</name>
</author>
<author><name sortKey="Jenkins, H" uniqKey="Jenkins H">H Jenkins</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Crosby, Ra" uniqKey="Crosby R">RA Crosby</name>
</author>
<author><name sortKey="Diclemente, Rj" uniqKey="Diclemente R">RJ DiClemente</name>
</author>
<author><name sortKey="Wingood, Gm" uniqKey="Wingood G">GM Wingood</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Fishbein, M" uniqKey="Fishbein M">M Fishbein</name>
</author>
<author><name sortKey="Pequegnat, W" uniqKey="Pequegnat W">W Pequegnat</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Jewkes, R" uniqKey="Jewkes R">R Jewkes</name>
</author>
<author><name sortKey="Nduna, M" uniqKey="Nduna M">M Nduna</name>
</author>
<author><name sortKey="Levin, J" uniqKey="Levin J">J Levin</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Koelle, Dm" uniqKey="Koelle D">DM Koelle</name>
</author>
<author><name sortKey="Wald, A" uniqKey="Wald A">A Wald</name>
</author>
</analytic>
</biblStruct>
<biblStruct><analytic><author><name sortKey="Martin, Et" uniqKey="Martin E">ET Martin</name>
</author>
<author><name sortKey="Krantz, E" uniqKey="Krantz E">E Krantz</name>
</author>
<author><name sortKey="Gottlieb, Sl" uniqKey="Gottlieb S">SL Gottlieb</name>
</author>
</analytic>
</biblStruct>
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</div1>
</back>
</TEI>
<affiliations><list><country><li>Tanzanie</li>
<li>États-Unis</li>
</country>
<region><li>Californie</li>
<li>Caroline du Nord</li>
<li>Massachusetts</li>
<li>Vermont</li>
<li>Washington (État)</li>
</region>
</list>
<tree><country name="États-Unis"><noRegion><name sortKey="De Walque, Damien" sort="De Walque, Damien" uniqKey="De Walque D" first="Damien" last="De Walque">Damien De Walque</name>
</noRegion>
<name sortKey="Dow, William H" sort="Dow, William H" uniqKey="Dow W" first="William H" last="Dow">William H. Dow</name>
<name sortKey="Gong, Erick" sort="Gong, Erick" uniqKey="Gong E" first="Erick" last="Gong">Erick Gong</name>
<name sortKey="Isdahl, Zachary" sort="Isdahl, Zachary" uniqKey="Isdahl Z" first="Zachary" last="Isdahl">Zachary Isdahl</name>
<name sortKey="Jamison, Julian" sort="Jamison, Julian" uniqKey="Jamison J" first="Julian" last="Jamison">Julian Jamison</name>
<name sortKey="Krishnan, Suneeta" sort="Krishnan, Suneeta" uniqKey="Krishnan S" first="Suneeta" last="Krishnan">Suneeta Krishnan</name>
<name sortKey="Medlin, Carol A" sort="Medlin, Carol A" uniqKey="Medlin C" first="Carol A" last="Medlin">Carol A. Medlin</name>
<name sortKey="Miguel, Edward" sort="Miguel, Edward" uniqKey="Miguel E" first="Edward" last="Miguel">Edward Miguel</name>
<name sortKey="Moncada, Jeanne" sort="Moncada, Jeanne" uniqKey="Moncada J" first="Jeanne" last="Moncada">Jeanne Moncada</name>
<name sortKey="Packel, Laura" sort="Packel, Laura" uniqKey="Packel L" first="Laura" last="Packel">Laura Packel</name>
<name sortKey="Schachter, Julius" sort="Schachter, Julius" uniqKey="Schachter J" first="Julius" last="Schachter">Julius Schachter</name>
</country>
<country name="Tanzanie"><noRegion><name sortKey="Nathan, Rose" sort="Nathan, Rose" uniqKey="Nathan R" first="Rose" last="Nathan">Rose Nathan</name>
</noRegion>
<name sortKey="Abdul, Ramadhani" sort="Abdul, Ramadhani" uniqKey="Abdul R" first="Ramadhani" last="Abdul">Ramadhani Abdul</name>
<name sortKey="Abilahi, Faraji" sort="Abilahi, Faraji" uniqKey="Abilahi F" first="Faraji" last="Abilahi">Faraji Abilahi</name>
<name sortKey="Jullu, Boniphace" sort="Jullu, Boniphace" uniqKey="Jullu B" first="Boniphace" last="Jullu">Boniphace Jullu</name>
<name sortKey="Majura, Albert" sort="Majura, Albert" uniqKey="Majura A" first="Albert" last="Majura">Albert Majura</name>
<name sortKey="Mtenga, Sally" sort="Mtenga, Sally" uniqKey="Mtenga S" first="Sally" last="Mtenga">Sally Mtenga</name>
<name sortKey="Mwanyangala, Mathew Alexander" sort="Mwanyangala, Mathew Alexander" uniqKey="Mwanyangala M" first="Mathew Alexander" last="Mwanyangala">Mathew Alexander Mwanyangala</name>
<name sortKey="Shirima, Kizito" sort="Shirima, Kizito" uniqKey="Shirima K" first="Kizito" last="Shirima">Kizito Shirima</name>
</country>
</tree>
</affiliations>
</record>

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Le SIDA en Afrique subsaharienne (serveur d'exploration)

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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