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

Damien de Walque, William Dow, Rose Nathan, Ramadhani Abdul, Faraji Abilahi, Erick Gong, Zachary Isdahl, Julian Jamison, Boniphace Jullu, Suneeta Krishnan, Albert Majura, Edward Miguel, Jeanne Moncada, Sally Mtenga, Mathew Alexander Mwanyangala, Laura Packel, Julius Schachter, Kizito Shirima and Carol A Medlin

Department of Economics, Working Paper Series from Department of Economics, Institute for Business and Economic Research, UC Berkeley

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.

Keywords: Public Health; Biomedical and Clinical Sciences; Clinical Sciences; Health Sciences; HIV/AIDS; Clinical Trials and Supportive Activities; Prevention; Behavioral and Social Science; Sexually Transmitted Infections; Infectious Diseases; Mental Health; Clinical Research; 3.1 Primary prevention interventions to modify behaviours or promote wellbeing; Prevention of disease and conditions; and promotion of well-being; Infection; Good Health and Well Being; Public Health and Health Services; Other Medical and Health Sciences; Biomedical and clinical sciences; Health sciences; Psychology (search for similar items in EconPapers)
Date: 2012-01-01
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Citations: View citations in EconPapers (39)

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