Economic strengthening for HIV prevention and risk reduction: a review of the evidence

Abstract

Household economic strengthening (HES) is increasingly implemented alongside HIV programing to address economic drivers of the epidemic. The evidence base on HES for HIV outcomes is growing, and this evidence review aimed to comprehensively consolidate and synthesize the research linking 15 types of HES interventions with a range of HIV prevention and treatment outcomes. The review was conducted between November 2015 and October 2016 and consisted of an academic database search, citation tracking of relevant articles, examination of secondary references, expert consultation, and a gray literature search. Studies were included if they evaluated an HES intervention(s), reported on an HIV outcome(s), were available in English, and were relevant to low-income contexts or vulnerable populations. All evidence was assessed for quality. Over 108 citations were included and a matrix framework was used to map the evidence, linking each HES intervention with each HIV outcome, providing a precise visual depiction of the evidence base. Given the volume of evidence, the results are presented and discussed in three papers, each focused on a different HIV outcome area. This is the first paper in the series and focuses on the 64 studies that reported HIV prevention outcomes. Conditional and unconditional cash transfers, and educational support were each associated with reductions in self-reported risk behaviors, particularly among adolescents. Food assistance in combination with other support also shows a positive trend for adolescent risk reduction. Most studies relied on self-reported behavioral data, and clinical outcomes such as HIV or other sexually transmitted infection (STI) incidence or prevalence were mostly null or underpowered, calling into question the true effectiveness of these interventions in preventing HIV. Limited evidence also supports the effectiveness of financial incentives in increasing voluntary medical male circumcision. Well-designed vocational/ entrepreneurial training and savings interventions could bolster HIV prevention efforts for female sex workers, while findings are less conclusive for adolescents.

Economic strengthening for HIV testing and linkage to care: a review of the evidence

“…Results for the full review are reported in the first paper in this series (Swann 2018a) including overall study characteristics, PRISMA diagram (see appendix 1) and full evidence map (see appendix 2) (Snilstveit, Vojtkova, Bhavsar, Stevenson, & Gaarder, 2016). UCTs are a common form of social protection that provide basic consumption support to stabilize vulnerable individuals or households.…”

“…The study limitations are discussed in greater detail in the first paper in this series (Swann 2018a). They include the introduction of reviewer bias in the inclusion of a quality assessment, which was mitigated through the creation of a structured codebook and using two reviewers.…”

“…The methodology of this review was described in detail in the first paper in this series, including a description of the search strategy, quality assessment approach and search terms (Swann 2018a). Briefly, the review was conducted between November 2015 and October 2016.…”

“…This is the second paper in a three-part series that comprehensively documents the published and gray literature linking a broad set of HES interventions to a range of HIV outcomes. This paper focuses on testing and linkage to care outcomes; the first and third papers in the series (Swann 2018a(Swann , 2018b cover prevention outcomes and clinical retention and antiretroviral therapy (ART) adherence outcomes, respectively (Table 1). Testing and linkage to care (including enrollment in care or ART initiation) are distinct areas of the HIV treatment cascade.…”

Building a theory of change for community development and HIV programming: The impact of social capital, stigma reduction and community-level changes on HIV-related health outcomes for orphans and vulnerable households in Mozambique

“…2 While existing research suggests that these programs have a positive impact on household and community resilience, there is little research to date that elucidates the causal pathways by which complex, multi-component OVC programs work with local social protection systems to achieve these outcomes. We also have little information on the specific causal pathways associated with ES in contributing to HIV-related outcomes, such as improved perceived health status or retention in HIV prevention or care, across individual and community levels (Swann, 2018). Our research aims to address this gap in the evidence through a qualitative case study to build a causal model mapping the impacts of a USAID program known as Community Care Program (CCP) on OVC households in the community of Mumemo in the Marracuene district of Mozambique.…”