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

Must be taking: HIV medication

Disqualifiers: Others

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

Compensation: Varies

Number of Visits: 3

80 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to explore how Universal Basic Income (UBI) might improve HIV care for Black men living with HIV in the Southern U.S. Participants will receive $500 each month for six months to determine if this aids in accessing HIV care and maintaining their medication routine. The study also examines whether this financial support enhances social connections and personal empowerment, both crucial for health. The trial seeks low-income Black men diagnosed with HIV who haven't consistently received HIV care recently. As an unphased study, this trial offers a unique opportunity to contribute to innovative research that could transform HIV care strategies.

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 prior data suggests that Universal Basic Income is safe for improving HIV care among Black men?

A review of various universal basic income (UBI) programs has shown positive effects on mental health. For example, one study found that people receiving a monthly cash payment reported improved mental well-being and reduced stress. Another study discovered that UBI served as a safety net, enabling people to cover essential living costs without conditions.

While few studies focus directly on UBI's safety, existing research suggests it is generally well-tolerated. UBI involves distributing cash, which is unlikely to cause harm. However, some studies note that although UBI can significantly boost household income, it may not always lead to expected improvements in all areas, such as health outcomes.

Overall, UBI is considered safe, as it provides money to assist with living costs. No reports have linked negative effects directly to receiving UBI itself. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Universal Basic Income (UBI) approach for HIV care because it's a novel way to address the socio-economic factors impacting health. Unlike traditional treatments that focus solely on medical interventions like antiretrovirals, UBI provides individuals with a monthly financial stipend, empowering them to manage resources that could improve their overall well-being. This method aims to reduce stress and improve adherence to HIV care by alleviating financial burdens, which is a unique angle compared to standard medical treatments. By potentially improving quality of life and health outcomes through financial stability, researchers are hopeful that UBI could complement existing HIV treatments in a meaningful way.

What evidence suggests that Universal Basic Income could be effective for HIV care?

This trial will evaluate the impact of Universal Basic Income (UBI) on healthcare use and health outcomes for people with HIV. Participants in the intervention arm will receive a monthly UBI stipend of $500 for six months. Research has shown that UBI can positively affect healthcare use and health outcomes. For people with HIV, UBI has improved mental health, helped meet basic needs, and strengthened social connections, all contributing to better health. Studies suggest that regular cash payments help people manage healthcare costs and adhere to treatments, increasing the likelihood of keeping the virus under control. In resource-limited areas, UBI has improved access to health services and reduced financial stress. Although limited studies specifically address Black men with HIV in the US, the overall benefits of UBI on health and well-being are encouraging. ^{1 2 4 6 7}

Who Is on the Research Team?

Ashley Williams, MHS

Principal Investigator

University of Arkansas

Are You a Good Fit for This Trial?

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 for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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 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 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]

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 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]

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]

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]

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]

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The $1,000 per month payment was approximately a 40% increase in total household income for the average participant. This substantial increase ...