Carries Stanley, Mkhwanazi Zibuyisile, Sithole Nokwanda, Sigwadhi Lovemore, Moshabela Mosa, Nyirenda Makandwe, Goudge Jane, Davids Eugene Lee, Govindasamy Darshini
Health Systems Research Unit, South African Medical Research Council, Durban, South Africa.
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
PLOS Glob Public Health. 2025 May 16;5(5):e0003799. doi: 10.1371/journal.pgph.0003799. eCollection 2025.
Caregivers of adolescents living with HIV encounter multiple economic and psycho-social challenges which impair their wellbeing and provision of optimal care. Cash transfers combined with short message service (SMS) nudges may address the financial and mental barriers to caregiver wellbeing in sub-Saharan Africa. We examined the preliminary effectiveness and feasibility outcomes of this multipronged approach for improving caregiver wellbeing. We piloted the Caregiver Wellbeing intervention in the eThekwini municipality, KwaZulu-Natal, South Africa. Participants were randomly assigned to one of the following groups: (i) the intervention arm (n = 50) received three cash payments (of ZAR 350, approximately 21 USD), coupled with behaviourally-informed mobile SMS nudges over a 3-month period; (ii) the control arm (n = 50) received a standard SMS encouraging linkage to health services. The primary outcome was change in psychological wellbeing at four-months follow-up. Secondary outcomes were changes in depressive symptoms and caregiver burden scores, recruitment pace, retention, uptake, acceptability and costs. Trial Registraion Number: PACTR202203585402090. The n = 100 caregivers (mean age = 42.3 years, 87% female) enrolled at baseline were recruited within six weeks. Compared to controls, there was a non-significant increase in psychological wellbeing (β = 3.14, p = 0.319). There was a 1.32 unit (p = 0.085) decrease in depressive symptoms and a reduction in caregiver burden (β = -1.28, p = 0.020) in the intervention arm. Participant retention was 85%, with high intervention uptake (95%). Caregivers expressed appreciation for the intervention as the cash component allowed them to fulfil their carer responsibilities and the SMS brought a sense of belonging and self-acceptance. Total societal cost of the intervention was US$13,549, and the incremental cost per increase in wellbeing score was US$1,080. Results suggest a cash transfer plus SMS nudge package, whilst feasible and acceptable, may require longer duration and an economic empowerment component to enhance caregiver wellbeing as part of post-pandemic recovery efforts.
感染艾滋病毒青少年的照顾者面临多种经济和心理社会挑战，这些挑战损害了他们的幸福感以及提供最佳护理的能力。现金转移支付与短信助推相结合，可能会消除撒哈拉以南非洲地区照顾者幸福感面临的经济和心理障碍。我们研究了这种多管齐下的方法在改善照顾者幸福感方面的初步有效性和可行性结果。我们在南非夸祖鲁 - 纳塔尔省德班市对照顾者幸福感干预措施进行了试点。参与者被随机分配到以下组之一：（i）干预组（n = 50）在3个月内收到三笔现金支付（350南非兰特，约合21美元），并收到基于行为学的手机短信助推；（ii）对照组（n = 50）收到一条鼓励与医疗服务机构建立联系的标准短信。主要结果是在4个月随访时心理健康状况的变化。次要结果包括抑郁症状和照顾者负担评分的变化、招募速度、留存率、接受率、可接受性和成本。试验注册号：PACTR202203585402090。在基线时登记的n = 100名照顾者（平均年龄 = 42.3岁，87%为女性）在六周内招募完成。与对照组相比，心理健康状况有不显著的增加（β = 3.14，p = 0.319）。干预组的抑郁症状减少了1.32个单位（p = 0.085），照顾者负担减轻（β = -1.28，p = 0.020）。参与者留存率为85%，干预接受率很高（95%）。照顾者对干预措施表示赞赏，因为现金部分使他们能够履行照顾责任，短信带来了归属感和自我认同感。干预措施的社会总成本为13,549美元，幸福感得分每增加一分的增量成本为1,080美元。结果表明，现金转移支付加短信助推方案虽然可行且可接受，但可能需要更长时间以及经济赋权部分，以增强照顾者的幸福感，作为疫情后恢复工作的一部分。
