Modeling Cash Plus Other Psychosocial and Structural Interventions to Prevent HIV Among Adolescent Girls and Young Women in South Africa (HPTN 068)

Marie C D Stoner,Kelly Kilburn,Kathleen Kahn,Jessie K Edwards,F Xavier Gómez-Olivé,Sheri A Lippman,Jennifer Ahern,Daniel Westreich,Audrey Pettifor

doi:10.1007/s10461-021-03158-3

Abstract

Poverty alleviation programs can reduce HIV incidence but may have greater impacts when combined with other psychosocial interventions. We modeled the change in HIV incidence among South African adolescent girls and young women (AGYW) associated with combining a cash transfer (the South African Child Support Grant (CSG)) with other structural and behavioral interventions. We modeled observational data from the HPTN 068 study where 2328 HIV negative AGYW (13–20 years) were followed for 4 years. In a Monte Carlo simulation based on this cohort (N = 10,000), CSG receipt was not independently associated with HIV incidence. Providing the CSG combined with increasing caregiver care and reducing adolescent depression had the largest reduction in HIV incidence with the fewest number of combined interventions (RD − 3.0%; (95% CI − 5.1%, − 0.9%). Combining a monthly grant with interventions to increase caregiver care and reduce adolescent depression could substantially reduce HIV incidence above the provision of cash alone.

Highlights

Cash transfer programs, where households or individuals receive cash payments, have been shown to mitigate the social determinants of HIV risk such as poverty and lack of education and to improve psychosocial outcomes including anxiety, self-esteem and hope for the future [1]
conditional cash transfer (CCT) randomization arm Double or single orphan Feels close to parent Perception that parent/guardian cares a lot or somewhat Household receiving any grants Receiving Child Support Grant (CSG) for at least one child in household Ever experienced any physical intimate partner violence (IPV) High attendance in school (≥ 80% school days) Children’s depression inventory score ≥ 7
At 4 years, the risk of HIV if all AGYW received a CSG at each visit was 4.9% compared to 8.4% if no one received a CSG for a risk difference (RD) of − 3.5% (95% Confidence Interval (CI) − 8.1%, 1.2% (Table 2))

Summary

Introduction

Cash transfer programs, where households or individuals receive cash payments, have been shown to mitigate the social determinants of HIV risk such as poverty and lack of education and to improve psychosocial outcomes including anxiety, self-esteem and hope for the future [1]. These programs are usually national government cash transfer or “social protection” programs provided to poor and vulnerable households to alleviate poverty and improve health outcomes. Given the success of these programs in improving school attendance and increasing household expenditures, cash payments have increasingly been studied as a strategy to prevent HIV infection. Most studies that have assessed the impact of cash transfer programs on HIV

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