81378 enGender Impact: The World Bank’s Gender Impact Evaluation Database Incentivizing safe sex: a randomized trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania Author(s) Damien de Walque, William Dow, Rose Nathan et al. Contact ddewalque@worldbank.org Country Tanzania Organizing Theme Health Status There was an additional follow-up in 2011 Intervention Category Cash Transfer Sector Health, Nutrition & Population Objective: The authors evaluated the use of conditional cash transfers as an HIV and sexually transmitted infection prevention strategy to incentivize safe sex. Design: An unblinded, individually randomised and controlled trial. Setting: 10 villages within the Kilombero/Ulanga districts of the Ifakara Health and Demographic Surveillance System in rural south-west Tanzania. Participants: The authors enrolled 2399 participants, aged 18e30 years, including adult spouses. Interventions: Participants were randomly assigned to either a control arm (n¼1124) or one of two intervention arms: low-value conditional cash transfer (eligible for $10 per testing round, n¼660) and highvalue conditional cash transfer (eligible for $20 per testing round, n¼615). The authors tested participants every 4 months over a 12-month period for the presence of common sexually transmitted infections. In the intervention arms, conditional cash transfer payments were tied to negative sexually transmitted infection test results. Anyone testing positive for a sexually transmitted infection was offered free treatment, and all received counselling. Main outcome measures: The primary study end point was combined prevalence of the Abstract four sexually transmitted infections, which were tested and reported to subjects every 4 months: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium. The authors also tested for HIV, herpes simplex virus 2 and syphilis at baseline and month 12. Results: At the end of the 12-month period, for the combined prevalence of any of the four sexually transmitted infections, which were tested and reported every 4 months (C trachomatis, N gonorrhoeae, T vaginalis and M genitalium), unadjusted RR for the high- value conditional cash transfer arm compared to controls was 0.80 (95% CI 0.54 to 1.06) and the adjusted RR was 0.73 (95% CI 0.47 to 0.99). Unadjusted RR for the high-value conditional cash transfer arm compared to the low-value conditional cash transfer arm was 0.76 (95% CI 0.49 to 1.03) and the adjusted RR was 0.69 (95% CI 0.45 to 0.92). No harm was reported. Conclusions: Conditional cash transfers used to incentivise safer sexual practices are a potentially promising new tool in HIV and sexually transmitted infections prevention. Additional larger study would be useful to clarify the effect size, to calibrate the size of the incentive and to determine whether the intervention can be delivered cost effectively Last updated: 14 August 2013 1 enGender Impact: The World Bank’s Gender Impact Evaluation Database Gender Connection Gender Focused Intervention Gender Outcomes Reproductive health IE Design Randomized Control Trial Participants were randomly assigned to either a control arm, or one f two intervention arms. The first intervention arm is a low-value conditional cash transfer of about $10 per testing round. The other arm had a cash transfer of about $20. The authors tested Intervention participants for common STDS every 4 months over a year. In the treatment arm cash transfers were tied to testing negative. Anyone who tested positive for STDs was offered free treatment and counseling. Intervention Period 1 year; individuals were tested once every 4 months The sample consisted of 2399 participants aged 18-30 years. Participants were excluded if Sample population they were pregnant at the time of the intervention, intended to permanently migrate out of area, or were unwilling to participate. The control group was tested for STDs and offered treatment if they tested positive, but Comparison conditions they did not receive any cash transfer if they tested negative. Unit of analysis Individual Level Evaluation Period February 2009-May 2010 The main outcome indicator is RR, the prevalence of STIs of the treatment group divided by the prevalence of STIs for the control group. The RR for the high value transfer was .8, but this is not statistically different than 0, but the adjusted RR did have a significant Results impact. While the unadjusted results are not significant for men and women, the results for just men are significant. The high-value treatment had a significantly greater impact than the low-value treatment. The results are limited to a 12 month experiment and cannot address the sustainability of Primary study limitations improvements. The study only measures the prevalence of 4 STDS and cannot determine the prevalence of others. World Bank Research Committee, the Spanish Impact Evaluation Fund, the Knowledge Funding Source for Change Program, the William and Flora Hewlett Foundation de Walque, D., Dow, W. H., Nathan, R., Abdul, R., Abilahi, F., Gong, E., ... & Medlin, C. Reference(s) A. (2012). Incentivizing safe sex: a randomized trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ open, 2(1). Link to Studies http://bmjopen.bmj.com/content/2/1/e000747.short Microdata Last updated: 14 August 2013 2