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Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?
Last registered on May 23, 2016

Pre-Trial

Trial Information
General Information
Title
Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?
RCT ID
AEARCTR-0001181
Initial registration date
May 23, 2016
Last updated
May 23, 2016 10:39 AM EDT
Location(s)
Region
Primary Investigator
Affiliation
University of Illinois at Urbana-Champaign
Other Primary Investigator(s)
PI Affiliation
Department of Sociology and Population Studies Center, University of Pennsylvania
Additional Trial Information
Status
Completed
Start date
2006-06-01
End date
2008-04-01
Secondary IDs
Abstract
Conditional cash transfers (CCTs) have recently received considerable attention as a potentially innovative and effective approach to the prevention of HIV/AIDS. We evaluate a conditional cash transfer program in rural Malawi which offered financial incentives to men and women to maintain their HIV status for approximately one year. The amounts of the reward ranged from zero to approximately 3–4 months wage. We find no effect of the offered incentives on HIV status or on reported sexual behavior. However, shortly after receiving the reward, men who received the cash transfer were 9 percentage points more likely and women were 6.7 percentage points less likely to engage in risky sex. Our analyses therefore question the “unconditional effectiveness” of CCT program for HIV prevention: CCT Programs that aim to motivate safe sexual behavior in Africa should take into account that money given in the present may have much stronger effects than rewards offered in the future, and any effect of these programs may be fairly sensitive to the specific design of the program, the local and/or cultural context, and the degree of agency an individual has with respect to sexual behaviors.
External Link(s)
Registration Citation
Citation
Kohler, Hans-Peter and Rebecca Thornton. 2016. "Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?." AEA RCT Registry. May 23. https://doi.org/10.1257/rct.1181-1.0.
Former Citation
Kohler, Hans-Peter and Rebecca Thornton. 2016. "Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?." AEA RCT Registry. May 23. https://www.socialscienceregistry.org/trials/1181/history/8432.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
Study participants were chosen from an older project, the Malawi Diffusion and Ideational Change Project (MDICP), where respondents were offered free door-to-door HIV testing and randomly assigned cash incentives to obtain their results from nearby testing centers. Among MDICP participants that agreed to be tested for HIV in 2006, 1307 were randomly invited to participate in this trial.

Both individuals and couples were enrolled in the trial and had to maintain their HIV status for one year in order to receive a cash incentive. Couples had to maintain the HIV status for both members to receive the money. The incentive amounts included (i) zero (ii) 500 Kwacha (approximately 4 U.S. dollars) (iii) 2,000 Kwacha (approximately 16 U.S. dollars) for an individual, or zero, 1,000 Kwacha, or 4,000 Kwacha (approximately 32 U.S. dollars) for a couple. The incentives represented a significant amount of money for respondents, with the higher amount equal to approximately three to four months wages.
Intervention Start Date
2006-08-01
Intervention End Date
2008-04-01
Primary Outcomes
Primary Outcomes (end points)
Sexual behavior
Primary Outcomes (explanation)
After the last round of surveys, a trained nurse visited each participant to test for HIV. Survey data is collected throughout and at the last survey round.
Secondary Outcomes
Secondary Outcomes (end points)
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
Sample participants were visited approximately three months to be asked about their sexual behavior in the previous nine days. The same questionnaire was administered each time. At the last survey, a nurse checked the HIV status of the respondent based on which the financial incentive was disbursed.

Individuals who were HIV-positive at the start of the program automatically received the monetary incentive at the end of the study. These individuals were included in the sample to avoid the possibility that being excluded from the study would signal their HIV positive status to outsiders.
Experimental Design Details
Randomization Method
Individual or couple randomly drew a token out of a bag to determine their incentive amount.
Randomization Unit
Individual participant
Was the treatment clustered?
No
Experiment Characteristics
Sample size: planned number of clusters
Study not clustered
Sample size: planned number of observations
1,307 individuals (men and women)
Sample size (or number of clusters) by treatment arms
Total: 1,307
Zero Incentive (control): 455
Medium Incentive 500 KMW per individual (treatment): 420
High Incentive 2000 KMW per individual (treatment): 432
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
With an enrollment of about 1,200 HIV-negative individuals at baseline of whom 84 percent participated in all three rounds of sexual diary surveys, the study would have been able to detect: with a probability of more than 90 percent (with a= 0.1), a 15 percent increase in having any vaginal sex during the nine days prior to each of the sexual diaries in response to receiving any incentive, a 15 percent increase in having safe sex—that is, it is equal to one if the respondent had sex with a condom or had no sex at all—during these periods, or a 15 percent decline in the number of days with vaginal sex during these periods. The sample size would have allowed us to detect with a probability of more than 75 percent a 25 percent increase in the probability of using condoms (conditional on having sex) or having condoms at home in response to receiving any incentives; with more than 80 percent probability, the study would have detected a 40 percent reduction in the probability of a woman being pregnant.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
University of Malawi
IRB Approval Date
2006-08-08
IRB Approval Number
P.05/06/443
IRB Name
University of Pennsylvania
IRB Approval Date
2006-04-12
IRB Approval Number
8 protocol 803914
IRB Name
University of Michigan
IRB Approval Date
2006-06-01
IRB Approval Number
HUM00011137
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
Yes
Intervention Completion Date
March 01, 2007, 12:00 AM +00:00
Is data collection complete?
Yes
Data Collection Completion Date
March 01, 2007, 12:00 AM +00:00
Final Sample Size: Number of Clusters (Unit of Randomization)
Study not clustered
Was attrition correlated with treatment status?
Final Sample Size: Total Number of Observations
1,193 individual participants analytical sample
Final Sample Size (or Number of Clusters) by Treatment Arms
Total: 1,193 individuals Analytical sample Zero Incentive (control): 407 Medium Incentive 500 KMW per individual (treatment): 383 High Incentive 2000 KMW per individual (treatment): 403
Data Publication
Data Publication
Is public data available?
No

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Program Files
Program Files
Reports and Papers
Preliminary Reports
Relevant Papers
Abstract
CONDITIONAL CASH TRANSFERS AND HIV/AIDS PREVENTION: UNCONDITIONALLY PROMISING?

Conditional cash transfers (CCTs) have recently received considerable attention as a potentially innovative and effective approach to the prevention of HIV/AIDS. We evaluate a conditional cash transfer program in rural Malawi which offered financial incentives to men and women to maintain their HIV status for approximately one year. The amounts of the reward ranged from zero to approximately 3–4 months wage. We find no effect of the offered incentives on HIV status or on reported sexual behavior. However, shortly after receiving the reward, men who received the cash transfer were 9 percentage points more likely and women were 6.7 percentage points less likely to engage in risky sex. Our analyses therefore question the “unconditional effectiveness” of CCT program for HIV prevention: CCT Programs that aim to motivate safe sexual behavior in Africa should take into account that money given in the present may have much stronger effects than rewards offered in the future, and any effect of these programs may be fairly sensitive to the specific design of the program, the local and/or cultural context, and the degree of agency an individual has with respect to sexual behaviors.

Citation
Kohler, Hans-Peter, and Rebecca Thornton. 2011. "Conditional Cash Transfers and HIV/AIDS Prevention: Unconditionally Promising?" World Bank Economic Review 26(2011): 165-190.v