Income determines the impact of cash transfers on HIV/AIDS: cohort study of 22.7 million Brazilians.

Autor: Silva AF; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil., Dourado I; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil., Lua I; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil., Jesus GS; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.; Faculty of Medicine, Federal University of Bahia (UFBA), Salvador, Brazil., Guimarães NS; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil., Morais GAS; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil., Anderle RVR; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil., Pescarini JM; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil., Machado DB; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil.; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA., Santos CAST; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil., Ichihara MY; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil., Barreto ML; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil., Magno L; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil.; Department of Life Sciences, State University of Bahia (UNEB), Salvador, Brazil., Souza LE; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil., Macinko J; Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA., Rasella D; Institute of Collective Health, Federal University of Bahia (UFBA), Salvador, Brazil. davide.rasella@gmail.com.; Center for Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Salvador, Brazil. davide.rasella@gmail.com.; ISGlobal, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain. davide.rasella@gmail.com.
Jazyk: angličtina
Zdroj: Nature communications [Nat Commun] 2024 Feb 12; Vol. 15 (1), pp. 1307. Date of Electronic Publication: 2024 Feb 12.
DOI: 10.1038/s41467-024-44975-z
Abstrakt: Living with extremely low-income is an important risk factor for HIV/AIDS and can be mitigated by conditional cash transfers. Using a cohort of 22.7 million low-income individuals during 9 years, we evaluated the effects of the world's largest conditional cash transfer, the Programa Bolsa Família, on HIV/AIDS-related outcomes. Exposure to Programa Bolsa Família was associated with reduced AIDS incidence by 41% (RR:0.59; 95%CI:0.57-0.61), mortality by 39% (RR:0.61; 95%CI:0.57-0.64), and case fatality rates by 25% (RR:0.75; 95%CI:0.66-0.85) in the cohort, and Programa Bolsa Família effects were considerably stronger among individuals of extremely low-income [reduction of 55% for incidence (RR:0.45, 95% CI:0.42-0.47), 54% mortality (RR:0.46, 95% CI:0.42-0.49), and 37% case-fatality (RR:0.63, 95% CI:0.51 -0.76)], decreasing gradually until having no effect in individuals with higher incomes. Similar effects were observed on HIV notification. Programa Bolsa Família impact was also stronger among women and adolescents. Several sensitivity and triangulation analyses demonstrated the robustness of the results. Conditional cash transfers can significantly reduce AIDS morbidity and mortality in extremely vulnerable populations and should be considered an essential intervention to achieve AIDS-related sustainable development goals by 2030.
(© 2024. The Author(s).)
Databáze: MEDLINE
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