CASH + CARE FOR ADOLESCENT HIV RISK REDUCTION

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Presentation transcript:

CASH + CARE FOR ADOLESCENT HIV RISK REDUCTION in DREAMS, Global Fund, 4Children, UNICEF and INSPIRE: CLUSTER RCT OF PARENTING FOR LIFELONG HEALTH L. Cluver, F. Meinck, J. Doubt, C Ward, C Lombard, Y Shenderovich, J Steinert, R Herrero Romero, S Medley, A Redfern, N Salah, S De Stone, L Ncobo, J Lachman, S Tsoanyane, H Loening, J Byrne, L Sherr, M Casale, F Gardner, C Wittesdale, R Catanho, S Hoeksma, C Mikton, A Butchart, J van der Wal, K Nocuza , M Pancoast, M Danisa, I Wessels, N Mukadah.

2016-18 Pragmatic Cluster RCT, Rural South Africa. N=1100 Reducing violence/economic strengthening Monitoring and praising teens Family problem-solving Family budgeting and saving Safety planning 2015 Pre-post test N=230 2014 Pre-post pilot N=60 Local community, trained by local NGO Village halls, churches, under trees (14 weeks) 40 villages & urban sites Stratified cluster-randomised, 9m follow-up 2013 Community consultation N=150 2012 Systematic review

Impacts on structural drivers of adolescent HIV Positive intervention effects IRR/d (95% CI) Less violence IRR.55 (.4,.75)*** More positive parenting d.25 (.03,.47)* More involved parenting d.86 (.64,1.1)*** Less poor supervision d-.05 (-.7,-.03)*** Less corporal punishment d.-46 (-.7,-.24)*** Less depression (carer) d-.33 (-.5,-.11)** Less parenting stress d-.37 (-.6,-.15)*** Less alcohol/drug use (carer) IRR.67 (.49-99)* Less alcohol/drug use (teen) IRR.55 (.33-93)* More social support (carer) d.31 (.09-.52)** More planning to protect teens in the community d.48 (.24-.72)*** Less shortfalls of food d-.62 (-.8-.40)*** More family savings d.31 (.09-.53)** Negative effects None No intervention effects Neglect Inconsistent discipline Depression (adolescent) Behavior problems Community violence exposure Cluver, L, Meinck, F, Steinert, J, et al (2018) BMJ Global Health.

Integration of HIV & violence prevention programming Cameroon Cote D’Ivoire DRC Haiti India Kenya Lesotho Malawi Nigeria Philippines South Africa South Sudan Swaziland Tanzania Thailand Uganda Zimbabwe Say it’s from RCTs and pre-post No need for any numbers or words on pic at all

Thank you.