The heterogeneous effect of short-term transfers for improving ART adherence among HIV-infected Tanzanian adults

Figures & data

Figure 1. Participant flowchart.

Table 1. Demographic and clinical characteristics of HIV-infected study participants in standard-of-care and food/cash transfer groups measured at baseline, Tanzania, 2014–2015.

Characteristic^a^,^b	Standard-of-care (n = 112)	Food/Cash (n = 688)
Sex
Male	39 (35)	252 (37)
Female	73 (65)	436 (63)
Age
Youth (18–35)	59 (53)	319 (46)
Non-youth (35+)	53 (47)	369 (54)
Language*
Swahili	80 (71)	409 (59)
Sukuma/Other	32 (29)	279 (41)
Marital status
Married	49 (44)	296 (43)
Household size
1 person	19 (17)	89 (13)
2 people	19 (17)	125 (18)
3 people	21 (19)	136 (20)
4 people	25 (22)	126 (18)
5 people	18 (16)	95 (14)
6+ people	10 (9)	49 (7)
Occupation*
Farmer	47 (42)	358 (52)
Other	65 (58)	330 (48)
Wealth quartile
Poorest quartile (1st)	23 (21)	177 (26)
Higher quartiles (2nd–4th)	89 (79)	511 (74)
WHO Clinical Stage*
1	14 (13)	95 (14)
2	41 (37)	188 (28)
3	46 (41)	355 (53)
4	10 (9)	34 (5)
Site of randomization
Shinyanga	26 (23)	162 (24)
Kahama	13 (12)	76 (11)
Kambarage	73 (65)	450 (65)
Time elapsed between HIV diagnosis and ART initiation
<90 days	85 (76)	518 (75)
≥90 days	27 (24)	170 (25)

^aAll values are in n (%).

^bStatistically significant p-values at p < 0.05 indicated with a *.

ART: Antiretroviral therapy.

Table 2. Predicted risks and risk differences of MPR ≥ 95% and LTFU for standard-of-care and food/cash groups, Tanzania, 2014–2016.

	6 Month MPR ≥ 95%^a (95% CI)^c	12 Month MPR ≥ 95% (95% CI)^c	12 Month LTFU^b (95% CI)^c
Standard-of-care (N = 112)	58 (50, 66)	47 (39, 56)	16 (8, 23)
Food/Cash (N = 688)	76 (72, 80)	60 (56, 65)	7 (5, 10)
Risk Difference	19 (11, 28)	15 (6, 24)	−9 (−16, −2)
p-value	<0.001	0.001	0.02

^aThe proportion of patients who were in possession of ≥1 antiretroviral or prescriptions for antiretroviral medication divided by the amount time between two prescriptions 95% of the time or greater (McMahon et al., 2011).

^bThe proportion of patients lost-to-follow-up, defined as anyone with more than ninety days from a missed scheduled clinical or drug pickup appointment (WHO, 2008).

^cModel adjusted for site of randomization.

MPR: medication possession ratio; LTFU: lost-to-follow-up; RD: risk difference.

Table 3. Predicted risk percentages for ART adherence and predicted risk differences between standard-of-care and food/cash groups, Tanzania, 2014–2016.

	6 Month MPR ≥ 95%^a (95% CI)^b		Risk Difference % (95% CI)		12 Month MPR ≥ 95%^a (95% CI)^b		Risk Difference % (95% CI)
	Standard-of-care	Food/Cash	Standard-of-care vs. Food/Cash	RERI p-value	Standard-of-care	Food/Cash	Standard-of-care vs. Food/Cash	RERI p-value
	N = 112	N = 688			N = 112	N = 688
Sex
Male	66 (52, 80)	83 (79, 87)	17 (1, 33)	0.71	55 (40, 69)	69 (64, 74)	15 (−3, 32)	0.99
Female	61 (51, 72)	82 (79, 85)	21 (8, 34)		55 (44, 65)	70 (66, 74)	15 (2, 28)
Age
Youth (18–35)	66 (55, 77)	82 (78, 85)	16 (3, 29)	0.41	56 (45, 67)	69 (64, 73)	13 (−1, 27)	0.64
Non-Youth (35+)	59 (46, 72)	83 (79, 86)	24 (8, 39)		53 (40, 66)	70 (66, 74)	17 (2, 32)
Time elapsed between HIV diagnosis and ART initiation
<90 days	58 (48, 68)	83 (80, 86)	25 (13, 36)	0.02	51 (41, 61)	71 (67, 74)	19 (7, 31)	0.09
≥90 days	79 (65, 94)	80 (74, 85)	0.3 (−17, 18)		67 (50, 83)	67 (60, 73)	−0.3 (−21, 20)
Wealth quartile
Lowest	51 (32, 71)	83 (78, 87)	32 (9, 55)	0.18	40 (20, 59)	68 (62, 74)	29 (5, 53)	0.14
Higher	66 (57, 75)	82 (78, 85)	16 (5, 27)		58 (49, 68)	70 (67, 74)	12 (0.3, 23)

^aThe proportion of patients who were in possession of ≥1 antiretroviral or prescriptions for antiretroviral medication divided by the amount time between two prescriptions 95% of the time or greater (McMahon et al., 2011).

^bModel adjusted for site of randomization.

MPR: medication possession ratio; ART: Antiretroviral therapy.

Table 4. Predicted risk percentages for LTFU and predicted risk differences between standard-of-care and food/cash groups, Tanzania, 2014–2016.

	12 Month LTFU^a % (95% CI)^b		Risk Difference % (CI)
	Standard-of-care	Food/Cash	Standard-of-care vs. Food/Cash	RERI p-value
	N = 112	N = 688
Sex
Male	24 (10, 37)	10 (6, 14)	−13 (−29, 2)	0.45
Female	13 (6, 21)	7 (5, 9)	−6 (−16, 3)
Age
Youth (18–35)	18 (8, 28)	8 (5, 11)	−10 (−22, 2)	0.77
Non-youth (35+)	15 (6, 25)	8 (5, 11)	−7 (−19, 4)
Time elapsed between HIV diagnosis and ART initiation
<90 days	17 (9, 25)	9 (7, 12)	−8 (−17, 2)	0.69
≥90 days	16 (2, 30)	4 (1, 7)	−11 (−28, 5)
Wealth quartile
Lowest	27 (8, 45)	8 (4, 12)	−19 (−41, 3)	0.30
Higher	14 (7, 22)	8 (6, 10)	−6 (−15, 2)

^aThe proportion of patients lost-to-follow-up, defined as anyone with more than ninety days from a missed scheduled clinical or drug pickup appointment (WHO, 2008).

^bModel adjusted for site of randomization.

LTFU: lost-to-follow-up; ART: Antiretroviral therapy.

Table A1. Predicted risk percentages for ART adherence and predicted risk differences between standard of care and food/cash groups.

	6 Month MPR ≥ 95%^a (95% CI)^b		Risk Difference % (CI)		12 Month MPR ≥ 95%^a (95% CI)^b		Risk Difference % (CI)
	Standard-of-care	Food/Cash	Standard-of-care vs. Food/Cash	RERI p-value	Standard-of-care	Food/Cash	Standard-of-care vs. Food/Cash	RERI p-value
	N = 112	N = 688			N = 112	N = 688
Time elapsed between HIV diagnosis and ART initiation
< 90 days	59 (49, 68)	83 (80, 86)	25 (13, 36)	0.13	51 (42, 61)	71 (67, 74)	20 (8, 31)	0.11
≥ 90 days	85 (67, 100)	77 (71, 84)	−8 (−29, 13)		70 (53, 87)	64 (55, 72)	−6 (−28, 15)

^aThe proportion of patients who were in possession of ≥1 antiretroviral or prescriptions for antiretroviral medication divided by the amount time between two prescriptions 95% of the time or greater (McMahon et al., 2011).

^bModel adjusted for site of randomization.

MPR: medication possession ratio; ART: Antiretroviral therapy.

Table A2. Predicted risk percentages for LTFU and predicted risk differences between standard-of-care and food/cash groups.

	12 Month LTFU^a % (95% CI)^b		Risk Difference % (CI)
	Standard-of-care	Food/Cash	Standard of care vs. Food/Cash	RERI p-value
	N = 112	N = 688
Time elapsed between HIV diagnosis and ART initiation
<90 days	16 (9, 24)	9 (7, 11)	−7 (−16, 2)	0.51
≥90 days	19 (2, 36)	3 (0.1, 7)	−16 (−35, 4)

^aThe proportion of patients lost-to-follow-up, defined as anyone with more than ninety days from a missed scheduled clinical or drug pickup appointment (WHO, 2008).

^bModel adjusted for site of randomization.

LTFU: lost-to-follow-up; ART: Antiretroviral therapy.

McMahon, J. H., Jordan, M. R., Kelley, K., Bertagnolio, S., Hong, S. Y., Wanke, C. A., … Elliott, J. H. (2011). Pharmacy adherence measures to assess adherence to antiretroviral therapy: Review of the literature and implications for treatment monitoring. Clinical Infectious Diseases, 52(4), 493–506. doi: 10.1093/cid/ciq167

 PubMed Web of Science ®Google Scholar

World Health Organization. (2008). Monitoring services, patients and programmes. In Operations manual for delivery of HIV prevention, care and treatment at primary health centres in high-prevalence, resource-constrained settings. Edition 1 for field testing and country adaptation. (Vol. 120). Geneva, Switzerland.

 Google Scholar