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The Effect of a Conditional Cash Transfer Program on Aids Morbidity and Mortality Among the Poorest: A Cohort Study of 22.7 Million Individuals in Brazil
27 Pages Posted: 10 Jan 2023
More...Abstract
Background: Poverty is an important risk factor for HIV/AIDS, and can be mitigated by social protection policies such as Conditional Cash Transfers (CCTs). We evaluated the effects of the world’s largest CCTs, the Programa Bolsa Família (PBF), on all sequential AIDS outcomes, using data from a large nationwide cohort of the poorest Brazilian people linked with all AIDS morbidity and mortality national records.
Methods: We developed a quasi-experimental impact evaluation using a cohort of 22.7 million low-income Brazilians during a 9-year period(2007-2015). We used inverse probability of treatment weighting (IPTW) to adjust for selection into receipt of PBF benefits and then fitted multivariable Poisson regressions, adjusted for all relevant socioeconomic, demographic, and healthcare confounding variables -at the individual and municipal level- to estimate the effect of PBF on AIDS incidence, mortality, and case fatality rates. We also evaluated PBF effects for different subpopulations according to per capita wealth, sex, and age.
Findings: Exposure to PBF was associated with significantly lower AIDS incidence (RR:0.59; 95%CI:0.57-0.61), mortality (RR:0.61; 95%CI:0.57-0.64), and case fatality rates (RR:0.75; 95%CI:0.66-0.85) in the overall cohort of individuals. PBF effects were considerably stronger among individuals living in extreme poverty (RR:0.45 for incidence; RR:0.46 for mortality and RR:0.63 for case fatality), and were gradually decreasing until showing no impact in the less poor individuals. PBF effects were also stronger among women (case fatality RR:0.65) and adolescents (incidence RR:0.48). Several sensitivity analyses demonstrated the robustness of the results, and triangulation analyses showed a high degree of confidence in the impact evaluation findings.
Interpretation: Conditional Cash Transfers can significantly reduce AIDS morbidity and mortality in poor populations. During the current dramatic rise in poverty rates due to the global economic crisis, CCT investments could protect against potential increases in the burden of HIV/AIDS, and contribute towards achieving the AIDS-related Sustainable Development Goal.
Funding Information: This study was supported by the US National Institute of Allergy and Infectious Diseases, National Institutes of Health (grant number 1R01AI152938).
Declaration of Interests: The authors declare no competing interests.
Ethics Approval Statement: This study was approved by the Research Ethics Committee of the Institute of Collective Health of the Federal University of Bahia (ISC/UFBA), under number 41691315.0.0000.5030 (Report No:3.783.920).
Keywords: Conditional Cash Transfers, HIV/AIDS, poverty, big data, impact evaluation, social determinants of health.
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