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Impact of a Conditional Cash Transfer on AIDS Incidence, Hospitalizations and Mortality in Brazil: A Nationwide Longitudinal Study
15 Pages Posted: 28 Dec 2021
More...Abstract
Background: Brazil has long been recognized for its strong response to the AIDS epidemic. However, one of the biggest challenges of this response has been reaching the poorest people. The country implemented one of the world’s largest Conditional Cash Transfer programmes, the Bolsa Familia Programme (BFP), which targeted poor individuals and contributed to the improvement of their socioeconomic conditions. This study aims to evaluate the impact of BFP coverage on AIDS incidence, hospitalizations and mortality in Brazil.
Methods: This study uses panel data from 5,507 Brazilian municipalities over the period 2004 to 2018 and fixed effects multivariable negative binomial regressions to estimate the effect of BFP coverage - classified as low (0% to 29%), intermediate (30% to 69%), and high (≥70%) - on the main AIDS outcomes (i.e., incidence, hospitalizations and mortality rates) adjusting for all relevant demographic, socioeconomic and healthcare covariates.
Findings: A high BFP coverage was associated with the reduction of AIDS incidence (Rate Ratio – RR:0.94; 95%CI:0.90-0.99), AIDS-related hospitalizations (RR:0.85; 95%CI:0.79-0.91) and AIDS mortality rates (RR:0.88; 95%CI:0.81-0.94). The effect on incidence was more pronounced in municipalities with higher AIDS endemicity levels (RR:0.86; 95%CI:0.80-0.94), among adult women (RR:0.85; 95%CI:0.77-0.93) and in children under 14 years old (RR:0.75; 95%CI:0.57-0.99).
Interpretation: This is the first study to comprehensively evaluate the impact of a Conditional Cash Transfer on AIDS in a LMIC over a 15-year period. The effect of BFP coverage on incidence, hospitalizations and mortality rates from AIDS in Brazil could be explained by the reduction of households’ poverty and by BFP health-related conditionalities. During the current dramatic rise in global poverty due to the COVID-19 pandemic, the protection of the most vulnerable populations through conditional cash transfers could avert potential changes in the trends of AIDS in LMIC.
Funding: National Institute of Allergy and Infectious Diseases (NIAID-NIH). Grant Number:1R01AI152938
Declaration of Interest: None to declare.
Ethical Approval: Ethical approval is not needed for this study.
Keywords: Conditional Cash Transfer, AIDS, Brazil
Suggested Citation: Suggested Citation