Department of Global Health, George Washington University, Washington, DC, USA.
Lancet. 2012 Apr 7;379(9823):1320-9. doi: 10.1016/S0140-6736(11)61709-1. Epub 2012 Feb 15.
Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women.
In this cluster randomised trial, never-married women aged 13-22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and randomly assigned with computer-generated random numbers by enumeration area (1:1) to receive cash payments (intervention group) or nothing (control group). Intervention enumeration areas were further randomly assigned with computer-generated random numbers to conditional (school attendance required to receive payment) and unconditional (no requirements to receive payment) groups. Participants in both intervention groups were randomly assigned by a lottery to receive monthly payments ranging from US$1 to $5, while their parents were independently assigned with computer-generated random numbers to receive $4-10. Behavioural risk assessments were done at baseline and 12 months; serology was tested at 18 months. Participants were not masked to treatment status but counsellors doing the serologic testing were. The primary outcomes were prevalence of HIV and herpes simplex virus 2 (HSV-2) at 18 months and were assessed by intention-to-treat analyses. The trial is registered, number NCT01333826.
88 enumeration areas were assigned to receive the intervention and 88 as controls. For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data, weighted HIV prevalence at 18 month follow-up was 1·2% (seven of 490 participants) in the combined intervention group versus 3·0% (17 of 799 participants) in the control group (adjusted odds ratio [OR] 0·36, 95% CI 0·14-0·91); weighted HSV-2 prevalence was 0·7% (five of 488 participants) versus 3·0% (27 of 796 participants; adjusted OR 0·24, 0·09-0·65). In the intervention group, we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence (3/235 [1%] vs 4/255 [2%]) or weighted HSV-2 prevalence (4/233 [1%] vs 1/255 [<1%]). For individuals who had already dropped out of school at baseline, we detected no significant difference between intervention and control groups for weighted HIV prevalence (23/210 [10%] vs 17/207 [8%]) or weighted HSV-2 prevalence (17/211 [8%] vs 17/208 [8%]).
Cash transfer programmes can reduce HIV and HSV-2 infections in adolescent schoolgirls in low-income settings. Structural interventions that do not directly target sexual behaviour change can be important components of HIV prevention strategies.
Global Development Network, Bill & Melinda Gates Foundation, National Bureau of Economic Research Africa Project, World Bank's Research Support Budget, and several World Bank trust funds (Gender Action Plan, Knowledge for Change Program, and Spanish Impact Evaluation fund).
教育程度低和经济上依赖男性，这些因素常被认为是女性感染艾滋病毒的重要危险因素。我们评估了现金转移方案对降低年轻女性性传播感染风险的效果。
在这项整群随机试验中，从未结婚的 13-22 岁女性，从马拉维赞比安区的 176 个普查区中招募，并通过普查区（1:1）以计算机生成的随机数随机分配接受现金支付（干预组）或不接受（对照组）。干预普查区进一步通过计算机生成的随机数随机分配为有条件（要求上学才能获得付款）和无条件（不要求获得付款）组。两组干预组的参与者通过抽签随机获得每月 1 至 5 美元的付款，而他们的父母则通过计算机生成的随机数独立获得 4-10 美元。在基线和 12 个月时进行行为风险评估；在 18 个月时进行血清学检测。参与者未对治疗情况进行盲法，但进行血清学检测的咨询员进行了盲法。主要结局是在 18 个月时 HIV 和单纯疱疹病毒 2（HSV-2）的流行率，采用意向治疗分析进行评估。该试验已注册，编号为 NCT01333826。
88 个普查区被分配接受干预，88 个作为对照。在基线时有完整访谈和生物标志物数据的 1289 名在校学生中，18 个月随访时，联合干预组中 HIV 流行率为 1.2%（490 名参与者中的 7 名），而对照组中为 3.0%（799 名参与者中的 17 名）（调整后的优势比[OR]0.36，95%CI0.14-0.91）；HSV-2 流行率为 0.7%（488 名参与者中的 5 名），对照组为 3.0%（796 名参与者中的 27 名）（调整后的 OR0.24，0.09-0.65）。在干预组中，我们没有注意到有条件干预组与无条件干预组之间的加权 HIV 流行率（3/235[1%]与 4/255[2%]）或加权 HSV-2 流行率（4/233[1%]与 1/255[<1%]）有差异。对于基线时已经辍学的个体，我们没有发现干预组与对照组之间的加权 HIV 流行率（23/210[10%]与 17/207[8%]）或加权 HSV-2 流行率（17/211[8%]与 17/208[8%]）有显著差异。
现金转移方案可以降低低收入环境中少女的 HIV 和 HSV-2 感染。不直接针对性行为改变的结构性干预措施可以成为艾滋病毒预防策略的重要组成部分。
全球发展网络、比尔和梅琳达盖茨基金会、国家经济研究局非洲项目、世界银行研究支持预算以及几个世界银行信托基金（性别行动计划、知识变革计划和西班牙影响评估基金）。
