Impact of Financial Incentives on Intimate Partner Violence for Women Living with HIV Initiating Antiretroviral Therapy

Financial incentives have demonstrated effectiveness in improving outcomes for people living with HIV; however, little is known about their impact on intimate partner violence (IPV) in this vulnerable population. A cluster-randomized trial investigating financial incentives and viral suppression was conducted in the Lake Zone of Tanzania (clinicaltrials.gov: NCT0420135). Between May 2021-March 2022, 32 clinics were randomized 1:1 to receive the standard of care (SOC) or to offer 22,500 TZS (similar to$10 USD) to individuals initiating antiretroviral therapy monthly for up to 6 months, conditional on clinic attendance. An intention-to-treat analysis was conducted to examine the effect of financial incentives on IPV among partnered women at 6 months (n = 494), with prevalence differences (PD) and 95% confidence intervals (CI) estimated using generalized estimating equations. Subgroup analyses were conducted among women partnered at 6 months only and women partnered at both baseline and 6 months. Past 6-month IPV was reported by 241 (48.8%) partnered women. Emotional IPV was the most common form of violence (47.8%), followed by physical (7.5%) and sexual IPV (5.1%). There were no significant differences in past 6-month IPV between arms in the primary (49.6% SOC vs. 48.1% incentive, PD: -0.02, 95% CI: -0.18, 0.15) or subgroup analyses. These findings suggest that small, short-term financial incentives used to improve HIV treatment outcomes do not significantly alter IPV risks, however with the width of the CIs it is not possible to rule out small and moderate-sized effects. Further research among larger samples is needed as financial incentive programs are brought to scale for people living with HIV.