The effect of protecting women against economic shocks to fight HIV in Cameroon, Africa: The POWER randomised controlled trial.

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2024-10-24 eCollection Date: 2024-10-01 DOI:10.1371/journal.pmed.1004355
Aurélia Lépine, Sandie Szawlowski, Emile Nitcheu, Henry Cust, Eric Defo Tamgno, Julienne Noo, Fanny Procureur, Illiasou Mfochive, Serge Billong, Ubald Tamoufe
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引用次数: 0

Abstract

Background: Women in sub-Saharan Africa are disproportionately affected by the HIV epidemic. Young women are twice as likely to be living with HIV as men of the same age and account for 64% of new HIV infections among young people. Many studies suggest that financial needs, alongside biological susceptibility, are a leading cause of the gender disparity in HIV acquisition. New robust evidence suggests women adopt risky sexual behaviours to cope with economic shocks, the sudden decreases in household's income or consumption power, enhancing our understanding of the link between poverty and HIV. We investigated if health insurance protects against economic shocks, reducing the need for vulnerable women to engage in risky sexual behaviours and reducing HIV and sexually transmitted infection (STI) incidence.

Method and findings: We conducted a randomised controlled trial to test the effectiveness of a formal shock coping strategy to prevent HIV among women at high risk of HIV (registration number: ISRCTN 22516548). Between June and August 2021, we recruited 1,508 adolescent girls and women over age 15 years who were involved in transactional sex (n = 753) or commercial sex (n = 755), using snowball sampling. Participants were randomly assigned (1:1) to receive free health insurance for themselves and their economic dependents for 12 months either at the beginning of the study (intervention; n = 579; commercial sex n = 289, transactional sex n = 290) from November 2021 or at the end of the study 12 months later (control; n = 568; commercial sex n = 290, transactional sex n = 278). We collected data on socioeconomic characteristics of participants. Primary outcomes included incidence of HIV and STIs and were measured at baseline, 6 months after randomisation, and 12 months after randomisation. We found that study participants who engaged in transactional sex and were assigned to the intervention group were less likely to become infected with HIV post-intervention (combined result of 6 months post-intervention or 12 months post-intervention, depending on the follow-up data available; odds ratio (OR) = 0.109 (95% confidence interval (CI) [0.014, 0.870]); p = 0.036). There was no evidence of a reduction in HIV incidence among women and girls involved in commercial sex. There was also no effect on STI acquisition among both strata of high-risk sexual activity. The main limitations of this study were the challenges of collecting reliable STI incidence data and the low incidence of HIV in women and girls involved in commercial sex, which might have prevented detection of study effects.

Conclusion: The study provides to our knowledge the first evidence of the effectiveness of a formal shock coping strategy for HIV prevention among women who engage in transactional sex in Africa, reinforcing the importance of structural interventions to prevent HIV.

Trial registration: The trial was registered with the ISRCTN Registry: ISRCTN 22516548. Registered on 31 July 2021.

在非洲喀麦隆,保护妇女免受经济冲击以抗击艾滋病毒的效果:POWER 随机对照试验。
背景:撒哈拉以南非洲地区的妇女受到艾滋病毒疫情的影响尤为严重。年轻女性感染艾滋病毒的几率是同龄男性的两倍,在新感染艾滋病毒的年轻人中占 64%。许多研究表明,除生理易感性外,经济需求也是导致感染艾滋病毒的性别差异的主要原因。新的有力证据表明,女性会采取危险的性行为来应对经济冲击,即家庭收入或消费能力的突然下降,这加深了我们对贫困与艾滋病之间联系的理解。我们研究了医疗保险是否能抵御经济冲击,从而减少弱势妇女对危险性行为的需求,降低艾滋病和性传播感染(STI)的发病率:我们开展了一项随机对照试验,以检验正式冲击应对策略在艾滋病高危女性中预防艾滋病的有效性(注册号:ISRCTN 22516548)。2021 年 6 月至 8 月期间,我们采用滚雪球抽样法招募了 1,508 名 15 岁以上的少女和妇女,她们参与了性交易(n = 753)或商业性行为(n = 755)。参与者被随机分配(1:1),从 2021 年 11 月起,在研究开始时(干预;n = 579;商业性行为 n = 289,交易性行为 n = 290)或 12 个月后研究结束时(对照;n = 568;商业性行为 n = 290,交易性行为 n = 278),为自己及其经济受抚养人获得为期 12 个月的免费医疗保险。我们收集了参与者的社会经济特征数据。主要结果包括艾滋病和性传播感染的发病率,分别在基线、随机分配后 6 个月和随机分配后 12 个月进行测量。我们发现,从事性交易并被分配到干预组的研究参与者在干预后感染 HIV 的几率较低(干预后 6 个月或干预后 12 个月的综合结果,取决于可用的随访数据;几率比 (OR) = 0.109(95% 置信区间 (CI) [0.014, 0.870]);p = 0.036)。没有证据表明参与商业性行为的妇女和女孩的艾滋病毒感染率有所下降。在高危性行为的两个阶层中,对性传播感染的感染率也没有影响。这项研究的主要局限性在于,收集可靠的性传播感染发病率数据存在挑战,而且参与商业性行为的妇女和女童的艾滋病发病率较低,这可能会阻碍研究效果的发现:据我们所知,这项研究首次证明了在非洲从事性交易的妇女中采用正式的冲击应对策略预防艾滋病的有效性,从而加强了结构性干预措施对预防艾滋病的重要性:该试验已在 ISRCTN 注册中心注册:ISRCTN 22516548.注册日期为 2021 年 7 月 31 日。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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