July 21, 2015
Written by HIV Prevention Trials Network (HPTN)
This post originally appeared on the HPTN website.
VANCOUVER, B.C. and DURHAM, N.C. – A Phase III, individually randomized trial has found conditional cash transfers for school attendance did not reduce the risk of HIV among high-school aged women in South Africa, investigators from the HIV Prevention Trials Network (HPTN) reported today at the 8th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver, Canada. The new finding is from HPTN 068, the first individually randomized study of young women conditioned on school attendance with an HIV incidence endpoint. In the trial, young women and their parent/guardian were randomized to one of two study arms: 1) a monthly cash transfer of 300 rand ($30) per month conditional on 80 percent school attendance, or 2) a control arm that did not receive cash transfer. Provision of cash conditional on school attendance has been proposed as an intervention for young women at high risk of HIV infection based on studies showing that such transfers are an effective way to keep girls in school and studies showing that schooling reduces HIV risk. Cash transfers have also been hypothesized to reduce young women’s HIV risk by decreasing their dependence on older male partners and transactional sex.
“Cash transfers play a key role in social protection in many settings including South Africa, but in this study setting they were not protective for acquiring HIV,” said Audrey Pettifor, Ph.D., associate professor in the Department of Epidemiology at the University of North Carolina at Chapel Hill and HPTN 068 study protocol chair. “School attendance was very high for young women in both arms of the study and staying in school reduced the risk of HIV acquisition. Overall HIV risk was low in the study population, much lower than anticipated, which may have affected the findings from this trial.”
The study found that there was no difference in HIV acquisition between the young women who received the cash transfer and those that did not. There were 59 incident HIV infections in the intervention arm and 48 in the control arm (hazard ratio 1.17 (95% CI 0.80-1.71, p=0.43)). Overall HIV incidence was 1.8% during the study, lower than the study team expected. Surprisingly, school attendance was high during the study; 95% of girls in both arms attended school, and there was no difference in school attendance between study arms. In line with the original hypothesis of the trial, young women who stayed in school and attended school more of the time across both arms of the study had a two-thirds reduced risk of acquiring HIV.