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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

See all articles by Andréa Silva

Andréa Silva

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

Inês Dourado

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

Iracema Lua

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

Gabriela dos Santos de Jesus

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

Nathalia Sernizon Guimarães

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

Gabriel AS Morais

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

Rodrigo Volmir Anderle

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

Julia Pescarini

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Daiane Machado

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS); Harvard University - Department of Global Health and Social Medicine

Carlos AST Santos

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Maria Yury Ichihara

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Mauricio L. Barreto

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

Laio Magno

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

Davide Rasella

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

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.

Suggested Citation

Silva, Andréa and Dourado, Inês and Lua, Iracema and Jesus, Gabriela dos Santos de and Guimarães, Nathalia Sernizon and Morais, Gabriel AS and Anderle, Rodrigo Volmir and Pescarini, Julia and Machado, Daiane and Santos, Carlos AST and Ichihara, Maria Yury and Barreto, Mauricio L. and Magno, Laio and Souza, Luis Eugenio de and Macinko, James and Rasella, Davide, 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. Available at SSRN: https://ssrn.com/abstract=4319344 or http://dx.doi.org/10.2139/ssrn.4319344

Andréa Silva

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

Inês Dourado

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

Iracema Lua

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

Gabriela dos Santos de Jesus

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

Nathalia Sernizon Guimarães

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

Gabriel AS Morais

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

Rodrigo Volmir Anderle

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

Julia Pescarini

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS)

Daiane Machado

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Harvard University - Department of Global Health and Social Medicine ( email )

Carlos AST Santos

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Maria Yury Ichihara

Oswaldo Cruz Foundation (FIOCRUZ) - Center for Data and Knowledge Integration for Health (CIDACS) ( email )

Bahia
Brazil

Mauricio L. Barreto

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

Laio Magno

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

Davide Rasella (Contact Author)

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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