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Cash vs. food assistance to improve adherence to antiretroviral therapy among HIV-infected adults in Tanzania

McCoy, Sandra I.a; Njau, Prosper F.b; Fahey, Carolyna; Kapologwe, Ntulic; Kadiyala, Suneethad; Jewell, Nicholas P.e; Dow, William H.f; Padian, Nancy S.a

doi: 10.1097/QAD.0000000000001406
Epidemiology and Social

Objective: We evaluated the effectiveness of short-term cash and food assistance to improve adherence to antiretroviral therapy (ART) and retention in care among people living with HIV in Tanzania.

Methods: At three clinics, 805 participants were randomized to three groups in a 3 : 3 : 1 ratio, stratified by site : nutrition assessment and counseling (NAC) and cash transfers (∼$11/month, n = 347), NAC and food baskets (n = 345), and NAC-only (comparison group, n = 113, NCT01957917). Eligible people living with HIV were at least 18 years, initiated ART 90 days or less prior, and food insecure. Cash or food was provided for 6 or less consecutive months, conditional on visit attendance. The primary outcome was medication possession ratio (MPR ≥ 95%) at 6 months. Secondary outcomes were appointment attendance and loss to follow-up (LTFU) at 6 and 12 months.

Results: The primary intent-to-treat analysis included 800 participants. Achievement of MPR ≥ 95% at 6 months was higher in the NAC + cash group compared with NAC-only (85.0 vs. 63.4%), a 21.6 percentage point difference [95% confidence interval (CI): 9.8, 33.4, P < 0.01]. MPR ≥ 95% was also significantly higher in the NAC + food group vs. NAC-only (difference = 15.8, 95% CI: 3.8, 27.9, P < 0.01). When directly compared, MPR ≥ 95% was similar in the NAC + cash and NAC + food groups (difference = 5.7, 95% CI: −1.2, 12.7, P = 0.15). Compared with NAC-only, appointment attendance and LTFU were significantly higher in both the NAC + cash and NAC + food groups at 6 months. At 12 months, the effect of NAC + cash, but not NAC + food, on MPR ≥ 95% and retention was sustained.

Conclusion: Short-term conditional cash and food assistance improves ART possession and appointment attendance and reduces LTFU among food-insecure ART initiates in Tanzania.

aDivision of Epidemiology, University of California, Berkeley, California, USA

bPrevention of Mother-to-Child HIV Transmission Programme, Ministry of Health, Community Development, Gender, Elderly, and Children, Dar es Salaam

cRegional Medical Office, Ministry of Health, Community Development, Gender, Equity, and Children, Shinyanga, Tanzania

dFaculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK

eDivision of Biostatistics

fDivision of Health Policy and Management, University of California, Berkeley, California, USA.

Correspondence to Sandra I. McCoy, MPH, PhD, Assistant Adjunct Professor, Division of Epidemiology, School of Public Health, University of California, 779 University Hall, MC 7360, Berkeley, CA 94720, USA. Tel: +1 510 642 0513; fax: +1 510 642 5018; e-mail:

Received 19 October, 2016

Revised 21 December, 2016

Accepted 4 January, 2017

Copyright © 2017 Wolters Kluwer Health, Inc.