Universal Basic Income for HIV Care

(017744S Trial)

Overseen By Ashley E Williams, MHS

Age: 18+

Sex: Male

Trial Phase: Academic

Sponsor: University of Arkansas

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 3

80 Participants Needed

Trial Summary

What is the purpose of this trial?

Universal Basic Income (UBI) is a promising strategy aimed at recalibrating economic systems that are grounded in structural racism. Black men have long been the target of oppressive and interconnected systems of finance and healthcare access, leading to a disproportionate burden of exposure to infectious disease with little healthcare support. Yet to our knowledge, no published UBI studies have ever been implemented exclusively with Black men living with HIV in the US. Motivated and inspired by the innovative health and social science being conducted in extremely resource-limited environments in other parts of the world, we recognize an urgent need to better understand the effect of cash transfers on HIV care among Black men in the US South. The proposed study will be based in Arkansas, which, like other Southern states, has a long history of institutional racism and extremely high rates of racial health disparities, poverty, and chronic disease. We will use a mixed methods research design to conduct an in-depth exploration of a UBI intervention to reduce the racial wage gap and promote the use of culturally relevant protective factors. The provision of a UBI is intended to increase receipt and retention of HIV care services and treatment for Black men through the influx of capital and subsequent increases in culturally-based protective factors such as personal agency and social connections. We hypothesize that providing UBI of $500 per month for 6 months will result in increased HIV care utilization among low-income Black men living with HIV. Secondarily, we hypothesize that the effect of UBI will also increase adherence to HIV medication, such that more UBI recipients will achieve and maintain viral suppression compared to individuals in the control condition.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on providing financial support to improve HIV care, so it's likely you can continue your current treatment, but you should confirm with the study team.

What data supports the effectiveness of Universal Basic Income as a treatment for HIV care?

Research on interventions similar to basic income shows mixed health effects, with some positive outcomes like improved mental health. Additionally, cash transfer programs have shown promise in reducing risky sexual behaviors, which could indirectly support HIV prevention. ^{1 2 3 4 5}

Is Universal Basic Income safe for humans?

There is limited evidence on the safety of Universal Basic Income itself, but studies on similar interventions show mixed health effects, with some positive outcomes like improved mental health and birthweight, and no large negative impacts on employment. ^{1 2 4 6 7}

How does Universal Basic Income differ from other treatments for HIV?

Universal Basic Income (UBI) is unique because it provides financial support to people living with HIV, helping them cover the costs of their care and improve their overall economic stability, unlike traditional treatments that focus solely on medical interventions like antiretroviral therapy. ^{6 8 9 10 11}

Research Team

Ashley Williams, MHS

Principal Investigator

University of Arkansas

Eligibility Criteria

This trial is for Black or African American men, at least 25 years old, living with HIV in central Arkansas. Participants must speak English, consent to the study, plan to stay in the area for the duration of the study, and share weekly employment-seeking activities and financial information. They should have an income up to 400% of the federal poverty threshold.

Inclusion Criteria

Self-identify as Black or African American

Plan to remain in the central Arkansas area for the duration of the study period

Be willing and able to provide weekly information about all activities related to seeking employment and to share financial and income-related information with the study team

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive a monthly UBI stipend of $500 for 6 months

6 months

Monthly visits for UBI distribution

Follow-up

Participants are monitored for HIV care utilization and medication adherence

6 months

3 visits (Baseline, 6-month, 12-month)

Treatment Details

Interventions

• Universal Basic Income

Trial Overview The trial tests if a Universal Basic Income (UBI) of $500 per month for six months can increase healthcare use among low-income Black men with HIV. It aims to see if UBI helps them get better access to care and improves adherence to HIV medication.

Participant Groups

Group I: Intervention Experimental Treatment 1 Intervention

Participants in Arm 2 will receive a monthly UBI stipend of $500 for 6 months. Study staff will explain that UBI payments will continue for 6 months and that the UBI payments will be suspended if an individual is reincarcerated (e.g. the participant will not receive UBI payments to their ClinCard during months of incarceration and will not receive additional months post-release from incarceration). Participants will receive their monthly UBI payment, along with all study-related compensation for completing baseline and follow-up assessments, through a ClinCard, which is a loadable debit card with an ID number unique to the participant. The UBI will be loaded to the participant's ClinCard on the first day of each month.

Group II: Control Active Control 1 Intervention

All participants will receive the following: 1) a ClinCard and instructions for completing a weekly financial journal to record participants' spending patterns and social needs during the first 6 months of the study; 2) materials about financial literacy and community-based resources that provide support to low-income individuals; 3) description and instructions for follow-up assessments and check-ins; 4) a copy of signed medical release, consent, and HIPAA forms; 5) respondent-driven sampling referral cards; 6) 3 study referral cards, and 7) information about voter registration services provided through the Pulaski County Circuit and County Clerk's Office (https://www.pulaskiclerk.com/voter-registration/). Participants will be provided information about the importance of voting, restoration of voting rights, and the process of voting and sealing records.

Who Is Running the Clinical Trial?

University of Arkansas

Lead Sponsor

Trials

500

Recruited

153,000+

Findings from Research

In a randomized clinical trial involving 120 drug users in India, modest voucher incentives significantly improved linkage to and retention in HIV care, with participants receiving incentives more likely to initiate antiretroviral therapy (ART) compared to those in the control group (27 vs 16 participants, P = .04).

While the voucher incentives led to more visits to the ART center (median visits of 8 vs 3.5, P = .005), they did not result in a significant difference in viral suppression, indicating that while incentives can help with care engagement, they may not directly affect treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India. Solomon, SS., Srikrishnan, AK., Vasudevan, CK., et al.[2022]

A systematic review of 27 studies on basic income-like interventions found mixed health effects, with notable positive impacts on outcomes like birthweight and mental health, but no significant effects on other health measures.

Employment outcomes varied, showing mostly small effects for men and larger positive effects for women with young children, suggesting that basic income may not lead to significant job loss and could improve certain socioeconomic conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The public health effects of interventions similar to basic income: a scoping review. Gibson, M., Hearty, W., Craig, P.[2023]

In a pilot study involving 86 individuals referred for antiretroviral therapy (ART), a cash incentive of R300 did not significantly improve linkage to care or ART initiation compared to a control group, with only 67% linking to care and 42% starting treatment within 3 months.

Although the incentive group linked to care and started treatment slightly faster, these differences were not statistically significant, indicating that economic incentives alone may not be sufficient to enhance ART uptake in resource-limited settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Conditional Economic Incentive Fails to Improve Linkage to Care and Antiretroviral Therapy Initiation Among HIV-Positive Adults in Cape Town, South Africa. Maughan-Brown, B., Smith, P., Kuo, C., et al.[2023]

Cash payments have been explored as a strategy for HIV prevention, with 16 studies identified, 10 of which are completed, primarily focusing on adolescents in developing countries.

Initial results indicate that cash transfer programs can lead to reductions in risky sexual behaviors and have shown a significant difference in HIV prevalence among young women receiving cash compared to those who do not.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can money prevent the spread of HIV? A review of cash payments for HIV prevention. Pettifor, A., MacPhail, C., Nguyen, N., et al.[2022]

A community-based antiretroviral treatment (ART) program in rural Uganda significantly improved household incomes by approximately 30% to 40% over one year, based on surveys of 134 households.

The health of nearly all patients improved as a result of the ART program, indicating that effective treatment of HIV/AIDS can lead to substantial economic benefits for households, highlighting the importance of investing in such health programs for overall development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of community-based HIV/AIDS treatment on household incomes in Uganda. Feulefack, JF., Luckert, MK., Mohapatra, S., et al.[2021]

A survey of 353 people living with HIV in Indonesia revealed that those in Jakarta and Jogjakarta spent a staggering 68% to 96% of their monthly income on HIV-related care, indicating a significant financial burden.

The study highlights that simply providing free antiretroviral therapy is not enough; additional financial support for comprehensive HIV care is necessary, especially since most respondents lacked health insurance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The financial burden of HIV care, including antiretroviral therapy, on patients in three sites in Indonesia. Riyarto, S., Hidayat, B., Johns, B., et al.[2015]

In a survey of 344 adults and 130 children living with HIV in Senegal, only 26% of adults, 18% of men who have sex with men (MSM), and 44% of children had health coverage under the national health system, Couverture Medicale Universelle (CMU).

Despite the existence of the CMU, the out-of-pocket expenses for routine consultations were €11 for adults and children, and €32.5 for MSM, indicating that the system is not effectively reducing healthcare costs for people living with HIV.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does universal health coverage reduce out-of-pocket expenditures for medical consultations for people living with HIV in Senegal? An exploratory cross-sectional study. Taverne, B., Laborde-Balen, G., Diaw, K., et al.[2023]

In a study involving 2170 HIV-infected individuals in Uganda, unconditional cash grants did not significantly improve health outcomes such as CD4 cell counts, medication adherence, or food security compared to those who did not receive the grants.

While the cash grants did not show important effects overall, there was a notable secondary finding suggesting that mental planning may positively influence CD4 cell count changes, indicating potential areas for further research.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Unconditional cash transfers for clinical and economic outcomes among HIV-affected Ugandan households. Mills, EJ., Adhvaryu, A., Jakiela, P., et al.[2022]

People living with HIV/AIDS in South Africa can access disability grants if they are unable to work due to their condition, but accessing antiretroviral treatment (ART) can lead to disqualification for these grants as their health improves.

This situation creates a dilemma for many individuals, as they must choose between receiving essential life-saving medication and maintaining their only source of income, highlighting the need for urgent discussions and potential solutions like a basic income grant for all South Africans.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disability grants or antiretrovirals? A quandary for people with HIV/AIDS in South Africa. Hardy, C., Richter, M.[2015]

A study of medically stable clients in HIV care revealed a significant unmet need for business capital, suggesting that microfinance and business training could greatly benefit individuals living with HIV/AIDS.

Participants who received microcredit loans demonstrated high repayment rates and significant increases in disposable income, profits, and savings, indicating the effectiveness of integrating economic support with HIV care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Microfinance Program Targeting People Living with HIV in Uganda: Client Characteristics and Program Impact. Linnemayr, S., Buzaalirwa, L., Balya, J., et al.[2022]

Microfinance interventions have been shown to improve key HIV treatment outcomes such as adherence, retention, and viral suppression, based on a systematic review of studies conducted from 1996 to 2018.

While all studies indicated positive effects on adherence and retention, the impact on CD4 cell count varied, suggesting that further research is needed to understand the specific mechanisms through which microfinance influences these treatment outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review. Nadkarni, S., Genberg, B., Galárraga, O.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Voucher incentives improve linkage to and retention in care among HIV-infected drug users in Chennai, India. [2022]

2. England pubmed.ncbi.nlm.nih.gov

The public health effects of interventions similar to basic income: a scoping review. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

A Conditional Economic Incentive Fails to Improve Linkage to Care and Antiretroviral Therapy Initiation Among HIV-Positive Adults in Cape Town, South Africa. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Can money prevent the spread of HIV? A review of cash payments for HIV prevention. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Impact of community-based HIV/AIDS treatment on household incomes in Uganda. [2021]

6. England pubmed.ncbi.nlm.nih.gov

The financial burden of HIV care, including antiretroviral therapy, on patients in three sites in Indonesia. [2015]

7. England pubmed.ncbi.nlm.nih.gov

Does universal health coverage reduce out-of-pocket expenditures for medical consultations for people living with HIV in Senegal? An exploratory cross-sectional study. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Unconditional cash transfers for clinical and economic outcomes among HIV-affected Ugandan households. [2022]

9. South Africa pubmed.ncbi.nlm.nih.gov

Disability grants or antiretrovirals? A quandary for people with HIV/AIDS in South Africa. [2015]

10. United States pubmed.ncbi.nlm.nih.gov

A Microfinance Program Targeting People Living with HIV in Uganda: Client Characteristics and Program Impact. [2022]

11. United States pubmed.ncbi.nlm.nih.gov

Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review. [2020]