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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

See all articles by Gabriel Alves de Sampaio Morais

Gabriel Alves de Sampaio Morais

Federal University of Bahia (UFBA) - Collective Health Institute

Laio Magno

Federal University of Bahia (UFBA) - Collective Health Institute

Andréa Silva

Federal University of Bahia (UFBA)

Nathalia Sernizon Guimarães

Federal University of Bahia (UFBA)

José Alejandro Ordoñez

Federal University of Bahia (UFBA) - Institute of Collective Health

Luis Eugenio de Souza

Federal University of Bahia (UFBA) - Institute of Collective Health

James Macinko

University of California, Los Angeles (UCLA) - Department of Community Health Sciences

Inês Dourado

Federal University of Bahia (UFBA) - Collective Health Institute

Davide Rasella

University of Barcelona - ISGlobal Hospital Clinic; Imperial College London; Federal University of Bahia (UFBA) - Institute of Collective Health

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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

Morais, Gabriel Alves de Sampaio and Magno, Laio and Silva, Andréa and Guimarães, Nathalia Sernizon and Ordoñez, José Alejandro and Souza, Luis Eugenio de and Macinko, James and Dourado, Inês and Rasella, Davide, Impact of a Conditional Cash Transfer on AIDS Incidence, Hospitalizations and Mortality in Brazil: A Nationwide Longitudinal Study. Available at SSRN: https://ssrn.com/abstract=3985387 or http://dx.doi.org/10.2139/ssrn.3985387

Gabriel Alves de Sampaio Morais (Contact Author)

Federal University of Bahia (UFBA) - Collective Health Institute ( email )

Rua Basílio da Gama, s/n
Salvador
Brazil

Laio Magno

Federal University of Bahia (UFBA) - Collective Health Institute ( email )

Av. Reitor Miguel Calmon, s/n
Vale do Canela
Salvador, Bahia
Brazil

Andréa Silva

Federal University of Bahia (UFBA) ( email )

Salvador
Brazil

Nathalia Sernizon Guimarães

Federal University of Bahia (UFBA) ( email )

Av. Reitor Miguel Calmon, s/n
Vale do Canela
Salvador, Bahia
Brazil

José Alejandro Ordoñez

Federal University of Bahia (UFBA) - Institute of Collective Health ( email )

Luis Eugenio de Souza

Federal University of Bahia (UFBA) - Institute of Collective Health ( email )

James Macinko

University of California, Los Angeles (UCLA) - Department of Community Health Sciences ( email )

650 Charles E. Young Drive South, 36-071 CHS
Box 951772
Los Angeles, CA 90095-1772
United States

Inês Dourado

Federal University of Bahia (UFBA) - Collective Health Institute ( email )

Av. Reitor Miguel Calmon, s/n
Vale do Canela
Salvador, Bahia
Brazil

Davide Rasella

University of Barcelona - ISGlobal Hospital Clinic ( email )

Barcelona
Spain

Imperial College London

South Kensington Campus
Exhibition Road
London, SW7 2AZ
United Kingdom

Federal University of Bahia (UFBA) - Institute of Collective Health ( email )

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