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Unconditional cash transfers for clinical and economic outcomes among HIV-affected Ugandan households

Mills, Edward J.a; Adhvaryu, Achyutab; Jakiela, Pamelac; Birungi, Josephined; Okoboi, Stephend; Chimulwa, Teddy Nabwire W.d; Wanganisi, Jonathane; Achilla, Tinaf; Popoff, Evang; Golchi, Shirina; Karlan, Deanh,i,j

doi: 10.1097/QAD.0000000000001899
Epidemiology and Social

Background: HIV infection has profound clinical and economic costs at the household level. This is particularly important in low-income settings, where access to additional sources of income or loans may be limited. While several microfinance interventions have been proposed, unconditional cash grants, a strategy to allow participants to choose how to use finances that may improve household security and health, has not previously been evaluated.

Methods: We examined the effect of an unconditional cash transfer to HIV-infected individuals using a 2 × 2 factorial randomized trial in two rural districts in Uganda. Our primary outcomes were changes in CD4+ cell count, sexual behaviors, and adherence to ART. Secondary outcomes were changes in household food security and adult mental health. We applied a Bayesian approach for our primary analysis.

Results: We randomized 2170 patients as participants, with 1081 receiving a cash grant. We found no important intervention effects on CD4+ T-cell counts between groups [mean difference 35.48, 95% credible interval (CrI) −59.9 to 1131.6], food security [odds ratio (OR) 1.22, 95% CrI: 0.47 to 3.02], medication adherence (OR 3.15, 95% CrI: 0.58 to 18.15), or sexual behavior (OR 0.45 95% CrI: 0.12 to 1.55), or health expenditure in the previous 3 weeks (mean difference $2.65, 95% CrI: −9.30 to 15.69). In secondary analysis, we detected an effect of mental planning on CD4+ cell count change between groups (104.2 cells, 9% CrI: 5.99 to 202.16). We did not have data on viral load outcomes.

Conclusion: Although all outcomes were associated with favorable point estimates, our trial did not demonstrate important effects of unconditional cash grants on health outcomes of HIV-positive patients receiving treatment.

aDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

bStephen M. Ross School of Business, University of Michigan, Ann Arbor, Michigan

cDepartment of Agriculture and Resource Economics, University of Maryland, College Park, Maryland

dThe AIDS Support Organization (TASO), Kampala, Uganda

eUS Centers for Disease Control and Prevention (CDC), Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Entebbe

fDeliverance Church Kololo, Kampala, Uganda

gPrecision Health Economics, Vancouver, Canada

hKellogg School of Management, Northwestern University, Evanston, Illinois

iInnovations for Poverty Action (IPA), New Haven, Connecticut

jM.I.T. Jameel Poverty Action Lab (J-PAL), Boston, Massachusetts, USA.

Correspondence to Edward J. Mills, PhD, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada. E-mail:

Received 12 November, 2017

Revised 7 February, 2018

Accepted 12 March, 2018

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Copyright © 2018 Wolters Kluwer Health, Inc.