IAS 2015: HPTN 068 and CAPRISA 007 cash incentive studies show value of school, financial support, but also show more is needed to protect young people from HIV

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IAS15

Science Speaks is covering the International AIDS Society 2015 Conference on HIV Pathogenesis, Treatment & Prevention in Vancouver, British Columbia from July 19-22, with reporting on breaking news and presentations from leading clinicians and researchers.

VANCOUVER, Canada –  Two clinical trials evaluating the impact of cash incentives on HIV incidence in adolescents  in South Africa found that such incentives had no impact on HIV rates  while one saw a decrease in rates of herpes simplex virus.

Nearly 3,000 South African high school students in 14 schools in high HIV incidence communities near Durban participated in CAPRISA 007, which Quarraisha Abdool Karim presented findings from Tuesday. The study tested the impact of cash incentives provided to high school students conditional on their participation in a life skills program, passing grades in 6 month academic exams, acceptance of a HIV test and /or the submission of a report, on their rates of herpes simplex virus 2 infection and HIV infection following students who were randomized to the cash incentive arm or a control arm. Those in the cash incentive group could receive up to $150 a month for participation in one or more of the activities. HIV and HSV2 testing was done at the beginning of the study and repeated at 12 and 24 months. Most of the students in the conditional cash incentive group chose participation in the life skills program and HIV testing to earn cash.

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Quarraisha Abdool Karim presents findings from CAPRISA 007

At the end of the study, boys in the incentive group showed a 40 percent lower rate of herpes infections, girls showed a 24 percent lower rate of herpes infections in girls,  compared to those in the control group for an overall reduction of 30 percent. Students who received more than $95 dollars in cash incentives had 71 percent lower rates of herpes infections than the control group. The number of HIV infections over the course of the study – 75 infections, 1.8 percent in the cash group and 1.5 percent in the control group was too small to detect a statistical difference between the two groups. The study found no impact on academic performance, although school attendance was high in both groups.

HPTN 068, a trial testing the theory that providing conditional cash incentives to keep adolescent girls in school will reduce HIV risk found no impact of cash incentives on the risk of HIV acquisition, Audrey Pettifor who presented the results of the study said.

This 3-year study enrolled 2448 HIV uninfected females aged 13-20 years old from 28 villages in the rural Mpumalanga province of South Africa with HIV prevalence of 46 percent. Girls and their parents or guardians in the cash transfer group received the equivalent of about $8 and $16 monthly,respectively, contingent on 80-percent school attendance. No difference in the relative risk of HIV acquisition between the two groups, showed at the end of the study period, with 59 infections in the cash incentive group and 48 infections in the control group. In both groups, school attendance was high and drop-out rates were low.

School enrolment and attendance protected girls from acquiring HIV irrespective of which study group they were in with drop-outs much more likely to acquire HIV. Young women who received cash reported fewer sex partners, less unprotected sex and less violence from intimate partners, as did young women from households with more economic resources. HPTN 068 continues with the goal of developing interventions to reduce HIV risk for these young women when they transition out of school.

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