Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Postgraduate Health Science, Medical Sciences College of Minas Gerais, Belo Horizonte, Brazil.
Institute of Collective Health, Federal University of Bahia, Salvador, Brazil; Department of Life Sciences, State University of Bahia, Salvador, Brazil.
Lancet HIV. 2023 Jun;10(6):e394-403. doi: 10.1016/S2352-3018(22)00290-9.
Poverty and social inequality are risk factors for poor health outcomes in patients with HIV/AIDS. In addition to eligibility, cash transfer programmes can be divided into two categories: those with specific requirements (conditional cash transfers [CCTs]) and those without specific requirements (unconditional cash transfers). Common CCT requirements include health care (eg, undergoing an HIV test) and education (eg, children attending school). Trials assessing the effect of cash transfer programmes on HIV/AIDS outcomes have yielded divergent findings. This review aimed to summarise evidence to evaluate the effects of cash transfer programmes on HIV/AIDS prevention and care outcomes.
For this systematic review and meta-analysis, we searched PubMed, EMBASE, Cochrane Library, LILACS, WHO IRIS, PAHO-IRIS, BDENF, Secretaria Estadual de Saúde SP, Localizador de Informação em Saúde, Coleciona SUS, BINACIS, IBECS, CUMED, SciELO, and Web of Science up to Nov 28, 2022. We included randomised controlled trials (RCTs) that evaluated the effects of cash transfer programmes on HIV incidence, HIV testing, retention in HIV care, and antiretroviral therapy adherence, and conducted risk of bias and quality of evidence assessments using the Cochrane Risk of Bias tool and the Grading of Recommendations, Assessment, Development, and Evaluations approach. A random-effects meta-analysis model was used to combine studies and calculate risk ratios (RRs). Subgroup analyses were performed using conditionality types (ie, school attendance or health care). The protocol was registered with PROSPERO, CRD42021274452.
16 RCTs, which included 5241 individuals, fulfilled the inclusion criteria. Of these, 13 studies included conditionalities for receiving cash transfer programmes. The results showed that receiving a cash transfer was associated with lowered HIV incidence among individuals who had to meet health-care conditionalities (RR 0·74, 95% CI 0·56-0·98) and with increased retention in HIV care for pregnant women (1·14, 95% CI 1·03-1·27). No significant effect was observed for HIV testing (RR 0·45, 95% CI 0·18-1·12) or antiretroviral therapy adherence (1·13, 0·73-1·75). Lower risk of bias was observed for HIV incidence and having an HIV test. The strength of available evidence can be classified as moderate.
Cash transfer programmes have a positive effect on mitigating HIV incidence for individuals who have to meet health-care conditionalities and on increasing retention in HIV care for pregnant women. These results show the potential of cash transfer programmes for HIV prevention and care, especially among people in extreme poverty, and highlight that cash transfer programmes must be considered when developing policies for HIV/AIDS control, as indicated by the UNAIDS 95-95-95 target of the HIV care continuum.
National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.
贫困和社会不平等是艾滋病毒/艾滋病患者健康结果不佳的风险因素。除了资格要求外，现金转移计划可以分为两类：有具体要求的计划（有条件现金转移[CCT]）和没有具体要求的计划（无条件现金转移）。常见的 CCT 要求包括医疗保健（例如，进行 HIV 检测）和教育（例如，儿童上学）。评估现金转移计划对艾滋病毒/艾滋病结果影响的试验得出了不同的发现。本综述旨在总结证据，以评估现金转移计划对艾滋病毒/艾滋病预防和护理结果的影响。
在本次系统评价和荟萃分析中，我们检索了 PubMed、EMBASE、Cochrane 图书馆、LILACS、世界卫生组织 IRIS、泛美卫生组织 IRIS、BDENF、圣保罗州立卫生秘书处、Localizador de Informação em Saúde、Coleciona SUS、BINACIS、IBECS、CUMED、SciELO 和 Web of Science，检索时间截至 2022 年 11 月 28 日。我们纳入了评估现金转移计划对艾滋病毒发病率、艾滋病毒检测、艾滋病毒护理保留率和抗逆转录病毒治疗依从性影响的随机对照试验（RCT），并使用 Cochrane 风险偏倚工具和推荐评估、制定与评估分级方法评估风险偏倚和证据质量。使用随机效应荟萃分析模型来合并研究并计算风险比（RR）。使用条件类型（即上学或医疗保健）进行亚组分析。该方案已在 PROSPERO 注册，注册号为 CRD42021274452。
符合纳入标准的 16 项 RCT 共纳入了 5241 名个体。其中，13 项研究包括接受现金转移计划的条件。结果表明，对于必须满足医疗保健条件的个体，接受现金转移与降低艾滋病毒发病率有关（RR 0.74，95%CI 0.56-0.98），并增加了孕妇的艾滋病毒护理保留率（1.14，95%CI 1.03-1.27）。对于艾滋病毒检测（RR 0.45，95%CI 0.18-1.12）或抗逆转录病毒治疗依从性（RR 1.13，95%CI 0.73-1.75），没有观察到显著效果。对于艾滋病毒发病率和进行艾滋病毒检测，风险偏倚较低。现有证据的强度可归类为中等。
现金转移计划对满足医疗保健条件的个体降低艾滋病毒发病率和增加孕妇艾滋病毒护理保留率具有积极影响。这些结果表明，现金转移计划在艾滋病毒预防和护理方面具有潜力，特别是在赤贫人群中，这突出表明，现金转移计划必须在制定艾滋病毒/艾滋病控制政策时予以考虑，这符合艾滋病规划署 95-95-95 艾滋病毒护理连续体目标。
美国国立过敏和传染病研究所，美国国立卫生研究院。
