Cash transfers for HIV prevention: A systematic review

Abstract

Background Given the success of cash programs in improving health outcomes and addressing upstream drivers of HIV risk such as poverty and education, there has been an increasing interest in their potential to improve HIV prevention and care outcomes. Recent reviews have documented the impacts of structural interventions on HIV prevention, but evidence about the effects of cash transfer programs on HIV prevention has not been systematically reviewed for several years. Methods and findings We did a systematic review of published and unpublished literature to update and summarize the evidence around cash programs for HIV prevention from January 2000 to December 17, 2020. We included studies with either a cash transfer intervention, savings program, or program to reduce school costs. Included studies measured the program’s impact on HIV infection, other sexually transmitted infections (STIs), or sexual behaviors. We screened 1,565 studies and examined 78 in full-text review to identify a total of 45 peer-reviewed publications and reports from 27 different interventions or populations. We did not do a meta-analysis given the range of outcomes and types of cash transfer interventions assessed. Most studies were conducted in sub-Saharan Africa (N = 23; South Africa, Tanzania, Malawi, Lesotho, Kenya, Uganda, Zimbabwe, Zambia, and eSwatini) followed by Mexico (N = 2), the United States (N = 1), and Mongolia (N = 1)). Of the 27 studies, 20 (72%) were randomized trials, 5 (20%) were observational studies, 1 (4%) was a case–control study, and 1 (4%) was quasi-experimental. Most studies did not identify a strong association between the program and sexual behaviors, except sexual debut (10/18 finding an association; 56%). Eight of the 27 studies included HIV biomarkers, but only 3 found a large reduction in HIV incidence or prevalence, and the rest found no statistically significant association. Of the studies that identified a statistically significant association with other STIs (N = 4/8), 2 involved incentives for staying free of the STI, and the other 2 were cash transfer programs for adolescent girls that had conditionalities related to secondary schooling. Study limitations include the small number of studies in key populations and examining interventions to reduce school costs and matched saving programs. Conclusions The evidence base for large-scale impacts of cash transfers reducing HIV risk is limited; however, government social protection cash transfer programs and programs that incentivize school attendance among adolescent girls and young women show the greatest promise for HIV prevention.

Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men

“…CM targets extrinsic motivation by providing tangible incentives as positive reinforcement for performing health behaviors [ 69 ], and it has also been successfully utilized to promote HIV-related health behavior change in people who use substances [ 70 – 75 ]. CM for stimulant abstinence has demonstrated some benefits for supporting PEP course completion by SMM [ 76 ], and ongoing trials are examining the benefits of CM for facilitating (re-)entry into the PrEP care continuum [ 77 ], as well as improving PrEP adherence of SMM who inject methamphetamine [ 78 ].…”

Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial

“…Our study contributes to the literature on cash transfer, as it reports the synergetic effect of cash transfer as a social protection scheme along with CHP among out-of-school girls where HIV infection is the highest. To our knowledge, only the adolescent girls’ initiative study in Kenya has been implemented in this group in sub-Saharan Africa [ 66 ]. Previous cash transfer interventions have produced mixed results, with some demonstrating impact on preventing sexually transmitted infections among school girls by delaying sexual activity [ 22 , 24 , 25 ].…”

Mechanisms for the prevention of adolescent intimate partner violence: A realist review of interventions in low- and middle-income countries

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