Computer-assisted Self-interview Research Articles

Automated wearable cameras for improving recall of diet and time use in Uganda: a cross-sectional feasibility study

BackgroundTraditional recall approaches of data collection for assessing dietary intake and time use are prone to recall bias. Studies in high- and middle-income countries show that automated wearable cameras are a promising method for collecting objective health behavior data and may improve study participants’ recall of foods consumed and daily activities performed. This study aimed to evaluate the feasibility of using automated wearable cameras in rural Eastern Ugandan to collect dietary and time use data.MethodsMothers of young children (n = 211) wore an automated wearable camera on 2 non-consecutive days while continuing their usual activities. The day after wearing the camera, participants’ dietary diversity and time use was assessed using an image-assisted recall. Their experiences of the method were assessed via a questionnaire.ResultsMost study participants reported their experiences with the automated wearable camera and image-assisted recall to be good (36%) or very good (56%) and would participate in a similar study in the future (97%). None of the eight study withdrawals could be definitively attributed to the camera. Fifteen percent of data was lost due to device malfunction, and twelve percent of the images were "uncodable" due to insufficient lighting. Processing and analyzing the images were labor-intensive, time-consuming, and prone to human error. Half (53%) of participants had difficulty interpreting the images captured by the camera.ConclusionsUsing an automated wearable camera in rural Eastern Uganda was feasible, although improvements are needed to overcome the challenges common to rural, low-income country contexts and reduce the burdens posed on both participants and researchers. To improve the quality of data obtained, future automated wearable camera-based image assisted recall studies should use a structured data format to reduce image coding time; electronically code the data in the field, as an output of the image review process, to eliminate ex post facto data entry; and, ideally, use computer-assisted personal interviews software to ensure completion and reduce errors. In-depth formative work in partnership with key local stakeholders (e.g., researchers from low-income countries, representatives from government and/or other institutional review boards, and community representatives and local leaders) is also needed to identify practical approaches to ensuring that the ethical rights of automated wearable camera study participants in low-income countries are adequately protected.

The Hong Kong youth epidemiological study of mental health (HK-YES)-A population-based psychiatric epidemiology study of youth mental health in Hong Kong: A study protocol.

Young people in Hong Kong have been facing numerous population-level events over the past year, including social unrest and the COVID-19 pandemic. Representative data concerning the mental health of youths, however, is limited. The Hong Kong Youth Epidemiological Study of Mental Health (HK-YES) is commissioned to provide the first representative prevalence estimates and correlates of mental disorders among young people in Hong Kong. It will also examine the help-seeking behaviours, treatment rates, quality of life, and functional outcomes of the young people. More importantly, the direct and indirect economic costs of mental disorders in youths will be estimated. A total of 4500 community-dwelling participants aged 15-24 years from Hong Kong will be surveyed. Participants will be selected using a multistage stratified sampling design to provide representative estimates of the youth population in Hong Kong. All interviews will be conducted using computer-assisted personal interviewing methods for assessments covering areas of psychiatric diagnoses, symptomatology, functioning, quality of life, disability, service utilization, health economic costs of mental disorders, and sociodemographic and lifestyle characteristics. A population-weighted prevalence will be estimated using survey weights. Methods such as multivariate logistic and linear regression analyses will be used to calculate the risks and odds of factors that might be associated with different mental disorders. As the first population-based youth study in Hong Kong, HK-YES collects extensive and representative data on different mental conditions and their associated factors among young people. The information gathered will be important for future planning on youth mental health services in Hong Kong and will offer the opportunity for a more meaningful comparison of data with other youth populations.

Does orthodontic treatment need have an impact on oral health-related quality of life?

The aims of this study were to determine the frequency of oral health-related quality of life (OHRQoL) impairment in anational representative sample of 8 to 9year olds in Germany and to evaluate the impact of orthodontic treatment need. Data were collected in the Sixth German Oral Health Study (Sechste Deutsche Mundgesundheitsstudie, DMS6) and subjects were sampled using amultistage sampling technique. OHRQoL was measured with amodified version of the 5‑item Oral Health Impact Profile (OHIP-5) which was administered in acomputer-assisted personal interview. Children were also examined for malocclusion and orthodontic treatment need. In all, 1892children aged 8-9years were invited to take part. Finally, data of 705children (48.6% female) could be included in the analysis. The OHIP‑5 mean was 1.3 (±2.0). There was no relevant influence from age and gender on the OHIP‑5 summary scores (r < 0.10), but the summary scores differed when analyzed separately regarding orthodontic treatment need or no orthodontic treatment need (1.5 ± 2.0 vs. 1.2 ± 1.9, p = 0.020). Nevertheless, the level appears to be low. Malocclusions with orthodontic treatment need have an influence on OHRQoL.

Relationship between gender equality, employees‘ perception of distributive justice and wellbeing in EU: The effect of gender and management position

We aim to evaluate relationships between gender equality, perceived distributive justice and wellbeing in the European Union (the EU). Further, this study includes an analysis of the moderating effects of gender and management position on the gender equality-distributive justice and distributive justice-wellbeing relationships. European Social Survey (ESS) Round 9 (2018/19) data file edition 3.1 was used for data analysis. Using probability sampling, ESS Round 9 data were collected in 27 European countries through computer-assisted personal (face-to-face) interviewing. The sample of this study consisted of 20 013 respondents (49.3% female) aged 18 and older (mean age – 44.8 years, std. dev. – 12.365) from 23 European Union countries. Results showed that a higher level of gender equality at work was related to higher employees’ satisfaction with life. Perceived job opportunities mediated the relationship between gender equality at work and employees’ satisfaction with life. Employees’ gender and management position moderated the relationship between perceived job opportunities and satisfaction with life. However, neither employees’ gender nor management position moderated the relationship between gender equality at work and perceived job opportunities.

HOUSEHOLD SIZE AND DAY OF THE WEEK AND THE LEVEL OF WASTED FOOD

Background. Food waste occurs in the entire food chain, but to the greatest degree in households. For this reason, it is important to know both the causes of this unfavourable phenomenon and its scale in the area of consumption. The aim of the study was to determine the volume of wasted food in 500 households and per household, taking into account five product groups, and to examine the relationship between the ousehold size and consecutive days of the week on the mass of wasted food. The study was carried out in 2019 on a representative, nationwide random quota sample of 500 households, at respondents' homes, for seven consecutive days. It consisted of two modules: an interview conducted by an interviewer (the Computer-Assisted Personal Interviews method) and a paper diary in which a person designated in a given household recorded the amount of food wasted on each subsequent day. Results and conclusions. Based on the study, it was found that in one week, an average of 3.9 kg of food was wasted in each household, of which over one-third of the average mass included inedible parts generated during food preparation. In an average household, fruit and vegetables were food products that were wasted during the week in the highest quantities, followed by bread and dairy products. It was found that in Polish households most food products and semifinished products were thrown away from a refrigerator and/or kitchen cupboards on Saturday. The dishes prepared at home and wasted to the highest degree were soups, which were disposed of mainly on Wednesday. More food was wasted in households with more than three people, compared to households with one and two people.

Assessing the multi-sectoral convergence of interventions impacting nutrition at the household level: Lessons from Sundarbans, West Bengal, India

Background: Malnutrition is a multifaceted problem requiring interventions that address the multi-sectoral determinants contributing to it. As per National Family Health Survey - 5 (2019-21), with 33.8% stunted, 20.3% wasted, and 32.2% underweight children, West Bengal is one of the high burden states for childhood undernutrition in India.&#x0D; Objectives: The objective of the study was to assess household-level access (i.e. the percentage of households availing select services) to various nutrition-specific and nutrition-sensitive interventions and understand the extent to which convergent action has taken place in the most hard-to-reach areas of the Sundarbans.&#x0D; Methods: Cross-sectional survey following 30 x 30 cluster sampling; the sampling was done based on population proportion to size (PPS) methodology. A total of 912 households were recruited for a quantitative survey, and the data was collected through computer-assisted personal interview (CAPI) tools. Data was collected from October 15-25, 2021 from households having at least one child in the age group of 6 – 24 months.&#x0D; Result: The study focused on 19 nutrition-specific and sensitive interventions. Household-level coverage of 13 of these interventions was 1.5%; coverage of the six others was 4.2%. The estimated coverage of all 19 interventions was found to be almost non-existent (0.2%).&#x0D; Conclusion: The conspicuously low coverage of services at the household level is a clear indicator of poor convergence of government schemes and programs, reflecting, in turn, disjointed action on the part of the various departments of the government. The results suggest the need for reconsidering the household-level delivery of services as a wholesome package of interventions rather than seeing them as discrete departmental deliverables.

Intellectual activity of primary school pupils during non-formal education classes – research report

The article presents the results of research on intellectual activity of primary school pupils participating in extracurricular activities, which were carried out under the program of the Ministry of Science and Higher Education entitled "Young Explorer's University". The research was carried out on specially organised classes in the form of non-formal education with a developed curriculum. The main research method was the diagnostic survey method, in which the technique was a questionnaire and the tool was a knowledge test. It was carried out using the Computer Assisted Personal Interview (CAPI) technique. In the article, most attention is paid to the change of intellectual activity in the context of pupils' cognitive processes in the adopted categories of tasks, i.e. memory, comprehension and use of information in typical and problematic situations, the concept of which was adopted on the basis of B. Niemierka's taxonomy.

FACTORS ASSOCIATED WITH COGNITIVE FUNCTION AMONG OLDER ADULTS IN VIETNAM

Abstract While Viet Nam is aging rapidly, there are few studies on cognitive function of older adults. We aimed to study status of cognitive function among older adults in Viet Nam and examine factors associated with cognitive function. The baseline data of the Longitudinal study of Ageing and Health in Viet Nam conducted in 2018/2019 was used for the study. LSAHV was a nationally representative survey of those aged 60 and above and computer-assisted personal interview (CAPI) using a tablet was conducted for data collection. The number of older person included in the study was 5,530. Cognitive function was measured by Short Portable Mental Status Questionnaire (SPMSQ). Factors such as demographic, socioeconomic, health behavior and daily activities such as reading newspaper were examined for their association with cognitive function by linear regression analyses. We found that better cognitive function was associated with engaging in physical activity in both male and female, listening to radio and receiving material support from children in male, and reading in female. Poorer cognitive function was associated with IADL limitation and financial support in both male and female, obesity in male, and hypertension and hearing loss in female. Our study provides an understanding of the associated factors with cognitive function of older people in Viet Nam. Some of the factors examined are modifiable and can be improved to prevent cognitive decline. It is also important to consider sex differences in planning and implementation of interventions and programs to prevent cognitive decline in Viet Nam.

Quality of Life in Children with Prader-Willi Syndrome and the Impact of the Disease on the Functioning of Families.

Objective: Prader−Willi (PWS; OMIM#176270) syndrome is a clinically distinct genetic disorder, caused by an abnormality in the 15q11-q13 region, referred to as the critical region. One of the most popular concepts existing in modern sciences, not only within psychology, but also in the aspect of all sciences that are related to human life and its course, is the quality of life (QoL). Though it is known that health-related quality of life in children with PWS can be reduced, less is understood about the impact on the family. We aimed to identify factors related to the quality of life of children with PWS and the impact of the disease on family functioning. Methods: A cross-sectional questionnaire survey. The subjects were 46 parents of children with PWS. The Computer Assisted Self-Interviewing (CASI) method was used; the Paediatric Quality of Life Inventory and the PedsQL Family Impact Module. Results: The PedsQL mean score was 49.0; (min−max: 5.6−90.8; SD = 16.8), with the highest scores in the Emotional Functioning (EF) (EF; 55.9; min−max: 5.0−100.0; SD = 22.0), and the lowest in the Social Functioning (SF) (SF; 42.7; min−max: 5.0−85.0; SD = 18.7) 56.4 (SD ± 14.7). The child’s age does not affect the quality of life, there were no statistically significant (p > 0.05). families have difficulties in performing daily activities (total score 27.6; SD 16.7), support family functioning (total score 28.9; SD 18.8) and effects physical domain (total score 27.7; SD 15.7). Conclusion: Research on the QoL of patients with PWS and their families is very important in order to assess the QoL, but also to provide the perspective of an active change in the perspective of a better treatment process, rehabilitation and communication in society.

Bacterial vaginosis-associated bacteria in cisgender men who have sex with women: prevalence, association with non-gonococcal urethritis and natural history

ObjectivesBacterial vaginosis-associated bacterium 2 (BVAB2), Mageeibacillus indolicus and Sneathia spp are highly predictive of bacterial vaginosis (BV) in cisgender women. They have been associated with non-gonococcal urethritis (NGU) in cisgender...

Young Employees’ Perceptions about Employability Skills for E-Commerce

With the digital transformation of businesses, digital marketing has been a prominent feature of organizations in the 21st century. Changing consumer behavior has also created a need for versatile hard and soft skills for marketing professionals. Inspired by the ongoing disruption to businesses across the world, this research focuses on employability skills in the field of e-commerce. A systematic review of the managerial research literature on digital marketing and e-commerce competencies has revealed a research gap regarding the investigation of the perceived importance of employability skills. The aim of this paper is to find out how important these skills are for future and current employees. The novelty of this study is the comparison between perceptions related to nonworking versus working young employees based on five key skill categories across 30 soft and hard skills. The study is quantitative in nature: a self-administered computer-assisted personal interviewing (CAPI) method is used for data collection. The findings reveal that the examined skills are perceived as important from the employee point of view. In addition to exploring the perceived relevance of the employability skills categories, the study identifies differences among the skills that young workers consider important in terms of their work experience. The research results reveal significant differences by work segments in relation to soft skills, such as teamwork, stress resilience, planning, organization and time management, precision, and attention to detail.

Leprosy among female prisoners in Brazil.

To estimate the prevalence of leprosy among Brazilian female prisoners and identify factors associated with the disease. Cross-sectional study conducted between 2014 and 2015 in 15 Brazilian female prisons. The data of 1,327 women were collected using Audio Computer-Assisted Self-Interviewing and dermatological and neurological examination to identify suspicious lesions of leprosy. The average age was 33.4 years. Suspicion of leprosy was identified in 5.1% of women in prison, and lifetime self-reported prevalence was 7.5%. The variables that were associated with lifetime self-reported leprosy were: women in prison once being twice as likely to have leprosy; white women were 1.4 time more likely to have leprosy than non-white women; women who knew someone with leprosy was 1.9 time more likely to have leprosy; and women who shared a cell with 11 or more women were 2.5 times more likely to have leprosy than women who shared a cell with two or fewer people. The leprosy prevalence among female prisoners in Brazil were greater than that found in a Brazilian woman of the general population and show the extremely high vulnerability of this population generated through pre-incarceration poverty, as well as potential transmission in prison.

Might Dog Walking Reduce the Impact of COPD on Patients' Life?

Low levels of physical activity (PA) lead to a worsening of physical condition and contributes to multimorbidity in Chronic Obstructive Respiratory Disease (COPD). Unsupervised PA related to dog ownership may contribute to reducing sedentary behavior. We aimed to investigate the relationship between dog walking, patient-reported outcomes (PROs) and exacerbations in COPD. A pre-defined sample of 200 COPD patients (dog owners and non-dog owners) with symptomatic COPD was sourced from a database representative of the Italian population. A computer-assisted personal interview was used to assess health status impairment (CAT), fatigue (FACIT), health-related quality of life (HRQoL) (EQ-5D), and PA frequency. In the whole sample, PA was associated with better CAT, EQ-5D, VAS, FACIT scores and reduced number of exacerbation (p &lt; 0.001). Under the same CAT scores, dog-walking duration was associated with a better HRQoL (EQ5D, p = 0.015) and less fatigue (FACIT, p = 0.017). In an adjusted regression model, walking dogs &gt;30 min was associated with lower fatigue (FACIT) than having no dogs and walking dogs &lt;15 min (p = 0.026 and p = 0.009, respectively). Motivation related to dog walking could modify patients' tendency to focus on symptoms during PA and, therefore, to perceive the fatigue. Dog walking may be effective for increasing and maintaining regular PA, reducing the subjective impact of COPD.

Is mild asthma truly mild? The patients’ real-life setting

ABSTRACT Objectives Asthma exacerbations and, more rarely, fatal asthma attacks have been reported in mild asthma patients, suggesting poor disease control and awareness of its potential burden. Our study aimed to explore outside the hospital/specialist setting the perspective and disease treatment behavior of patients self-reporting a mild asthma diagnosis. Methods Computer-Assisted Personal Interviewing (CAPI) technique was used to investigate the identified study population. Questions about diagnosis, symptoms, comorbidities, treatment strategy, ongoing assessments, and quality of life were administered. Results Overall, 258 patients were considered for the analysis. As the most relevant results, 22% of them reported severe respiratory symptoms, 52% experienced at least one exacerbation/year, and 7% needed Emergency Room care. Sixty-six percent of the respondents assumed as needing short-acting bronchodilators only. Of note, 22% of patients were using oral steroids (OCS) intermittently and 72% of them considered their quality of life unsatisfying. Conclusion Outside the hospital/specialist setting, mild asthma burden is still not negligible and the treatment approach is not correct. In particular, the reported OCS use is disproportionate. Our data suggest that mild asthma, especially when self-assessed might be other than mild, suggesting that efforts to increase disease awareness, improve the disease control limiting the OCS abuse are required.

Some Aspects of Women’s Health in Republic of Macedonia

INTRODUCTION: Sex and gender "matters" in terms of the health status as well as a result of both biological and gender-related differences.&#x0D; AIM: To analyze sex and gender-based differences in North Macedonia through analysis of some aspects of mortality, the knowledge and attitudes related to women’s health.&#x0D; METHODS: Analysis of the general and age-standardized mortality patterns and CAPI (Computer-assisted personal interview) composed on different topics including women's health for the period 2017-2020 were used.&#x0D; RESULTS: Age-standardized mortality rates (all-causes of death, circulatory and respiratory diseases and neoplasms) are prevalent and higher in the male population in North Macedonia. A significantly higher all-cause mortality trend for both sexes was found in 2020 making this year hardly comparable with the previous years. A decreasing trend of malignant neoplasms rate of female genital organs and an increasing trend of breast cancer mortality is observed.&#x0D; The majority of the respondents (50.6%) rated their current health status as excellent with a statistically significant difference between the age and ethnical groups. One-third of the respondents reported regular physical activity, mostly on a daily basis. The majority (39.3%) are overweight and 27.5% belongs to the obesity class I without a significant difference in terms of ethnicity.&#x0D; Respondents (27%), reported that have high blood pressure, 20.2% vaginal infections, 19.9% allergies, heart issues 15.1%, anemia 11.7%, while diabetes and cancer 8.5% and 2.5% respectively. The youngest and oldest age group of Albanian women are the least informed about the early detection procedures of malignant compared to Macedonian women and other ethnic groups.&#x0D; CONCLUSIONS: Analyzing some aspects of women's health in North Macedonia through the mortality, knowledge and attitudes of Macedonian women, we provide some further evidence for the development and implementation of targeted interventions and policies aimed to reduce the sex and gender-based health inequalities in the country.

Sexual and Contraceptive Behaviour of Adolescents and Young Adults in Germany

Abstract Background For 40 years the Federal Centre for Health Education in Germany has been analysing the contraception behaviour of young people. The current Survey is the ninth iteration, carried out in 2019. This continuous monitoring generates insights on the sexual and reproductive health of young people in Germany. The survey provides an important basis for the development of sexuality education and family planning measures. Methods A total of N = 6032 adolescents and young adults participated in the survey. Date collection was conducted by computer-assisted personal interviewing (CAPI). The current sexual and contraceptive behaviour of adolescents and young adults will be summarized using descriptive results. In addition, the association between contraception non-use and sociodemographic factors, characteristics of sexuality education and situated factors of first sexual intercourse is analysed by multivariate logistic regressions. Results A key finding of this iteration is that with regards to the age of the first sexual intercourse, the proportion of adolescents younger than 17 years has been declining for several years. For contraception, adolescents most frequently used condoms, and use of the pill has decreased. 9% of the participants reported non-contraception use at first sexual intercourse. This is significantly associated (p &amp;lt; .01) with unexpected and only unilaterally desired sexual intercourse and the absence of sexuality education in School. In addition, the younger the adolescence were at first sexual intercourse the greater the risk for contraception non-use. Conclusions The data from the current iteration indicate safe and responsible contraceptive behaviour among young people in Germany. It is important to maintain the commitment in the field of sexual health promotion and expand prevention measures for young people. This is the only way to ensure the sexual and reproductive health also in the next generation. Key messages

Association of Number of Teeth with ADL/IADL in Korean Middle-Aged and Older Adults: An Analysis of the 7th Korean Longitudinal Study of Aging.

We determined the association between the number of natural and implant teeth with activities of daily living (ADL) and instrumental ADL (IADL) levels in middle-aged and older adults aged ≥ 55 years. We included 6,925 participants, who underwent a computer-assisted personal interview in the 7th Korean Longitudinal Study of Aging. After controlling for general characteristics, the associations between the number of natural and implant teeth with ADL and IADL levels were examined using multiple regression analysis. The participants had 21.2 natural teeth and 1.08 implant teeth on average. The ADL and IADL levels were 0.61 and 1.56, 0.40 and 1.16, and 1.10 and 0.31 in participants with ≤ 9, 10–19, and ≥ 20 teeth, respectively. There was no significant association between ADL and the number of natural and implant teeth (p > 0.05). However, a one-unit increase in IADL score was associated with a reduced number of natural (β = −0.031, p < 0.001) and implant (β = −0.194, p = 0.006) teeth. Difficulties regarding IADL were associated with fewer natural and implant teeth, suggesting that maintaining and managing the number of teeth is critical to promoting the health of middle-aged and older adults.

Value Set for the EQ-5D-Y-3L in Hungary.

BackgroundThe Hungarian health technology assessment guidelines recommend the use of the EuroQol instrument family in quality-adjusted life-year calculations. However, no national value set exists for the EQ-5D-Y-3L or any other youth-specific instrument.ObjectiveThis study aims to develop a national value set of the EQ-5D-Y-3L for Hungary based on preferences of the general adult population.MethodsThis study followed the international valuation protocol for the EQ-5D-Y-3L. Two independent samples, representative of the Hungarian general adult population in terms of age and sex were recruited to complete online discrete choice experiment (DCE) tasks and composite time trade-off (cTTO) tasks by computer-assisted personal interviews. Adults valued hypothetical EQ-5D-Y-3L health states considering the health of a 10-year-old child. DCE data were modelled using a mixed logit model with random-correlated coefficients. Latent DCE utility estimates were mapped onto mean observed cTTO utilities using ordinary least squares regression.ResultsOverall, 996 and 200 respondents completed the DCE and cTTO surveys, respectively. For each domain, the value set resulted in larger utility decrements with more severe response levels. The relative importance of domains by level 3 coefficients was as follows: having pain or discomfort > feeling worried, sad or unhappy > mobility > doing usual activities > looking after myself. Overall, 12.3% of all health states had negative utilities in the value set, with the worst health state having the lowest predicted utility of − 0.485.ConclusionThis study developed a national value set of the EQ-5D-Y-3L for Hungary. The value set enables to evaluate the cost utility of health technologies for children and adolescents based on societal preferences in Hungary.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-022-01190-2.

Family influence and succession strategies in private businesses at the cusp of leadership change: comparison between family firms and lone founder enterprises

PurposeThis paper investigates the impact of family influence measured by the F-PEC scale on private enterprise (both family firms and lone founders) leadership succession strategy.Design/methodology/approachThe research dataset is comprised of 390 private enterprises whose head offices were situated in the voivodeships of Lower Silesia and Wielkopolska in Poland. The authors collected data through CAPI (computer-assisted personal interviewing) method, as well as through comprehensive, structured interviews with company owners. Data were analysed using hierarchical logistic regression for each type of succession strategy.FindingsThe results suggest that increased family influence does not necessarily lead to intra-family leadership succession in private enterprises. Importantly, a range of findings contradicted authors' predictions. The relationship between the overall F-PEC scale values signifying the multi-faceted family influence over the business and the choice of internal successor was weakly negative for the total sample; also, the higher the overlap between family and business values and the higher the commitment to family business, as evidenced by the Culture subscale, the lower was the occurrence of intra-family successor choice in the population of lone founders. The Culture subscale also increased the prevalence of lack of succession planning in the sample of lone founders.Originality/valueWhile several studies suggests that family firms may be more prone to choose an intra-family succession scenario, it remains unclear how lower levels of business and succession experience, may influence the successor choice. Indeed, some studies suggest that a strong family influence over a business, may stimulate family firms to choose a family outsider as a business leader. Therefore, the key contribution of this study is contextualizing the response to an ongoing succession debate. This study investigates the strategic choices of companies in the first generation of ownership operating in Poland, which serves as an example of a post-transition economy. While the characteristics of this economic environment may be unique, the authors discuss how the surprising findings may add to the understanding of the general succession processes present in private enterprises.

Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial.

BackgroundPoverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk.ObjectiveThis study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior.MethodsA cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit.ResultsOf the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders.ConclusionsAlthough this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer.Trial RegistrationClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243