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Effects of short-term cash and food incentives on food insecurity and nutrition among HIV-infected adults in Tanzania

a randomized trial

Fahey, Carolyn A.a; Njau, Prosper F.b; Dow, William H.c; Kapologwe, Ntulid; McCoy, Sandra I.a

doi: 10.1097/QAD.0000000000002056

Objective: Food insecurity (FI) impedes antiretroviral therapy (ART) adherence. We previously demonstrated that short-term cash and food incentives increased ART possession and retention in HIV services in Tanzania. To elucidate potential pathways that led to these achievements, we examined whether incentives also improved FI.

Design: Three-arm randomized controlled trial.

Methods: From 2013 to 2015, 805 food-insecure adult ART initiates (≤90 days) at three clinics were randomized to receive cash or food transfers (∼$11/month for ≤6 months, conditional on visit attendance) or standard-of-care (SOC) services. We assessed changes from baseline to 6 and 12 months in: FI (severe; access; dietary diversity), nutritional status (body weight; body-mass index), and work status. Difference-in-differences average treatment effects were estimated using inverse-probability-of-censoring weighted longitudinal regression models.

Results: The modified intention-to-treat analysis included 777 non-pregnant participants with 41.6% severely FI. All three study groups experienced improvements from baseline in FI, nutritional status, and work status. After 6 months, severe FI declined within the cash [−31.4 percentage points (pp) to 11.5%] and food (−30.3 to 10.4%) groups, but not within the SOC. Relative to the SOC, severe FI decreased by an additional 24.3 pp for cash (95% CI: −45.0, −3.5) and 23.3 pp for food (95% CI: −43.8, −2.7). The interventions did not augment improvements in severe FI at 12 months, nor food access, dietary diversity, nutritional status, or work status at 6 or 12 months.

Conclusions: Small cash and food transfers provided at treatment initiation may mitigate severe FI. These effects may have facilitated previously observed improvements in ART adherence.

aDivision of Epidemiology, School of Public Health, University of California, Berkeley, California, USA

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

cDivision of Health Policy and Management, School of Public Health, University of California, Berkeley, California, USA

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

Correspondence to Carolyn A. Fahey, Division of Epidemiology, School of Public Health, 2121 Berkeley Way, Room 5302, University of California, Berkeley, Berkeley, CA 94720. Tel: +1 510 643 273111; fax: +1 510 643 5676; e-mail:

Received 10 June, 2018

Accepted 27 September, 2018

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