HPTN 068

Effects of cash transfer for the prevention of HIV in young South African women

Study Summary

What is HPTN 068?

HPTN 068 was a Phase III research study determine whether providing cash transfers to young women and their household, conditional on school attendance, reduced young women’s risk of acquiring HIV. The overall goal of the Conditional Cash Transfer (CCT) intervention was to reduce structural barriers to education with the goal of increasing school attendance of young women, hereby decreasing their HIV risk.

Who participated in the study?

A total of 2,533 young women were enrolled between March 2011 and December 2012. Participants enrolled in the study were aged 13-20 years, in high school, not married or pregnant, and resided in the Medical Research Council (MRC) / Wits University Agincourt Health and Socio-Demographic Surveillance System (AHDSS) study site. This region is a rural area of Mpumalanga Province in South Africa that is characterized by high HIV prevalence, poverty, and migration for work.

What happened during the study?

In the trial, young women and their parent/guardian were randomized to one of two study arms: 1) a monthly cash transfer of 300 South-African rand per month conditional on 80 percent school attendance, or 2) a control arm that did not receive cash transfer.

Why is this study important?

Young women in South Africa face an extremely high risk of HIV infection. More than 11 percent of young women ages 14 to 24 are living with HIV, compared to less than three percent of men in the same age group. The effect of cash transfers on HIV prevention for young women may depend on the local context. Cash transfers to keep girls in school may have a greater impact in settings where secondary school enrollment is low for young women. The effect of cash transfers to reduce HIV risk behavior through mechanisms other than school attendance will likely be dependent on factors driving HIV risk and how likely it is that those behaviors can be altered by cash, which will largely be dependent on the local context.

Results:

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.