东津巴布韦现金转移试验对艾滋病病毒溢出预防效果的影响：一项集群随机试验和一般人群调查的证据。
Spillover HIV prevention effects of a cash transfer trial in East Zimbabwe: evidence from a cluster-randomised trial and general-population survey.
机构信息
MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
Department of Health Policy, London School of Economics and Political Science, London, UK.
出版信息
BMC Public Health. 2020 Oct 23;20(1):1599. doi: 10.1186/s12889-020-09667-5.
BACKGROUND
Benefits of cash transfers (CTs) for HIV prevention have been demonstrated largely in purposively designed trials, commonly focusing on young women. It is less clear if CT interventions not designed for HIV prevention can have HIV-specific effects, including adverse effects. The cluster-randomised Manicaland Cash Transfer Trial (2010-11) evaluated effects of CTs on children's (2-17 years) development in eastern Zimbabwe. We evaluated whether this CT intervention with no HIV-specific objectives had unintended HIV prevention spillover effects (externalities).
METHODS
Data on 2909 individuals (15-54 years) living in trial households were taken from a general-population survey, conducted simultaneously in the same communities as the Manicaland Trial. Average treatment effects (ATEs) of CTs on sexual behaviour (any recent sex, condom use, multiple partners) and secondary outcomes (mental distress, school enrolment, and alcohol/cigarette/drug consumption) were estimated using mixed-effects logistic regressions (random effects for study site and intervention cluster), by sex and age group (15-29; 30-54 years). Outcomes were also evaluated with a larger synthetic comparison group created through propensity score matching.
RESULTS
CTs did not affect sexual debut but reduced having any recent sex (past 30 days) among young males (ATE: - 11.7 percentage points [PP] [95% confidence interval: -26.0PP, 2.61PP]) and females (- 5.68PP [- 15.7PP, 4.34PP]), with similar but less uncertain estimates when compared against the synthetic comparison group (males: -9.68PP [- 13.1PP, - 6.30PP]; females: -8.77PP [- 16.3PP, - 1.23PP]). There were no effects among older individuals. Young (but not older) males receiving CTs reported increased multiple partnerships (8.49PP [- 5.40PP, 22.4PP]; synthetic comparison: 10.3PP (1.27PP, 19.2PP). No impact on alcohol, cigarette, or drug consumption was found. There are indications that CTs reduced psychological distress among young people, although impacts were small. CTs increased school enrolment in males (11.5PP [3.05PP, 19.9PP]). Analyses with the synthetic comparison group (but not the original control group) further indicated increased school enrolment among females (5.50PP [1.62PP, 9.37PP]) and condom use among younger and older women receiving CTs (9.38PP [5.90PP, 12.9PP]; 5.95PP [1.46PP, 10.4PP]).
CONCLUSIONS
Non-HIV-prevention CT interventions can have HIV prevention outcomes, including reduced sexual activity among young people and increased multiple partnerships among young men. No effects on sexual debut or alcohol, cigarette, or drug consumption were observed. A broad approach is necessary to evaluate CT interventions to capture unintended outcomes, particularly in economic evaluations.
TRIAL REGISTRATION
ClinicalTrials.gov , NCT00966849 . Registered August 27, 2009.
背景
现金转移（CT）对 HIV 预防的益处已在有针对性设计的试验中得到证明，这些试验通常集中在年轻女性身上。目前尚不清楚，针对 HIV 预防而设计的 CT 干预措施是否会产生 HIV 特定的效果，包括不良效果。2010-2011 年在津巴布韦东部进行的马尼亚兰现金转移试验评估了 CT 对儿童（2-17 岁）发育的影响。我们评估了这种没有 HIV 特定目标的 CT 干预措施是否具有意外的 HIV 预防溢出效应（外部性）。
方法
从与马尼亚兰试验同时在同一社区进行的一般人群调查中，获取了 2909 名（15-54 岁）居住在试验家庭中的个人的数据。使用混合效应逻辑回归（研究地点和干预集群的随机效应）按性别和年龄组（15-29 岁；30-54 岁）估计 CT 对性行为（任何近期性行为、使用避孕套、多个性伴侣）和次要结局（精神困扰、入学率以及酒精/香烟/毒品使用）的平均治疗效果（ATE）。还使用通过倾向评分匹配创建的更大的综合比较组来评估结果。
结果
CT 并没有影响性初潮，但减少了年轻男性（ATE：-11.7%[95%置信区间：-26.0%，2.6%]）和女性（ATE：-5.68%[-15.7%，4.34%]）最近有过性行为，当与综合比较组相比时，估计值相似但不太确定（男性：-9.68%[-13.1%，-6.3%]；女性：-8.77%[-16.3%，-1.2%]）。对于年龄较大的个体没有影响。接受 CT 的年轻（但不是年长）男性报告称多伴侣关系增加（8.49%[-5.4%，22.4%]；综合比较组：10.3%[1.2%，19.2%]）。未发现酒精、香烟或毒品消费有任何影响。有迹象表明 CT 减少了年轻人的心理困扰，尽管影响很小。CT 增加了男性的入学率（11.5%[3.05%，19.9%]）。使用综合比较组（而不是原始对照组）的分析进一步表明，接受 CT 的女性入学率增加（5.50%[1.62%，9.37%]），年轻和年长女性使用避孕套的比例增加（9.38%[5.9%，12.9%]；5.95%[1.46%，10.4%]）。
结论
非 HIV 预防 CT 干预措施可以产生 HIV 预防效果，包括减少年轻人的性活动和增加年轻男性的多伴侣关系。没有观察到对性初潮或酒精、香烟或毒品消费的影响。为了评估 CT 干预措施以捕获意外结果，特别是在经济评估中，需要采取广泛的方法。
试验注册
ClinicalTrials.gov，NCT00966849。2009 年 8 月 27 日注册。
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