The effect of becoming a legal sex worker in Senegal on health and wellbeing

Senegal is the only low-income country where prostitution is legal and regulated by a health policy. To solicit clients in public places, female sex workers need to register with a health facility and attend monthly routine health checks aiming at testing and treating sexually transmitted infections and distributing free condoms. While this policy was first introduced in 1969 to limit the spread of sexually transmitted infections, there is no evidence so far on its impact on sex workers\u27 health. The paper aims to fill this gap by exploiting a unique data set of legal and illegal Senegalese sex workers. Using propensity score matching we find that becoming a registered sex worker leads to an improvement in health but has a detrimental effect on wellbeing. Precisely, registered sex workers are found to engage in riskier and more degrading sex acts and to have less social support from their co-workers. Our results are robust to the use of a super learner to improve the specification of the propensity score and the use of entropy balancing in order to achieve covariate balance. The results are also robust to the violation of the conditional independence assumption. The results suggest that psychological services should be offered to sex workers part of the registration policy in order to overcome its negative effect on wellbeing

Investigating interventions to increase uptake of HIV testing and linkage into care or prevention for male partners of pregnant women in antenatal clinics in Blantyre, Malawi: study protocol for a cluster randomised trial.

BACKGROUND: Despite large-scale efforts to diagnose people living with HIV, 54% remain undiagnosed in sub-Saharan Africa. The gap in knowledge of HIV status and uptake of follow-on services remains wide with much lower rates of HIV testing among men compared to women. Here, we design a study to investigate the effect on uptake of HIV testing and linkage into care or prevention of partner-delivered HIV self-testing alone or with an additional intervention among male partners of pregnant women. METHODS: A phase II, adaptive, multi-arm, multi-stage cluster randomised trial, randomising antenatal clinic (ANC) days to six different trial arms. Pregnant women accessing ANC in urban Malawi for the first time will be recruited into either the standard of care (SOC) arm (invitation letter to the male partner offering HIV testing) or one of five intervention arms offering oral HIV self-test kits. Three of the five intervention arms will additionally offer the male partner a financial incentive (fixed or lottery amount) conditional on linkage after self-testing with one arm testing phone call reminders. Assuming that 25% of male partners link to care or prevention in the SOC arm, six clinic days, with a harmonic mean of 21 eligible participants, per arm will provide 80% power to detect a 0.15 absolute difference in the primary outcome. Cluster proportions will be analysed by a cluster summaries approach with adjustment for clustering and multiplicity. DISCUSSION: This trial applies adaptive methods which are novel and efficient designs. The methodology and lessons learned here will be important as proof of concept of how to design and conduct similar studies in the future. Although small, this trial will potentially present good evidence on the type of effective interventions for improving linkage into ART or prevention. The trial results will also have important policy implications on how to implement HIVST targeting male partners of pregnant women who are accessing ANC for the first time while paying particular attention to safety concerns. Contamination may occur if women in the intervention arms share their self-test kits with women in the SOC arm. TRIAL REGISTRATION: ISRCTN, ID: 18421340 . Registered on 31 March 2016

The effect of demand-side financial incentives for increasing linkage into HIV treatment and voluntary medical male circumcision: A systematic review and meta-analysis of randomised controlled trials in low- and middle-income countries

INTRODUCTION: Linkage to HIV treatment is a vital step in the cascade of HIV services and is critical to slowing down HIV transmission in countries with high HIV prevalence. Equally, linkage to voluntary medical male circumcision (VMMC) has been shown to decrease HIV transmission by 60% and increasing numbers of men receiving VMMC has a substantial impact on HIV incidence. However, only 48% of newly diagnosed HIV positive people link to HIV treatment let alone access HIV prevention methods such as VMMC globally. METHODS: A systematic review investigating the effect of demand-side financial incentives (DSFIs) on linkage into HIV treatment or VMMC for studies conducted in low- and middle-income countries. We searched the title, abstract and keywords in eight bibliographic databases: MEDLINE, EMBASE, Web of Science, Econlit, Cochrane, SCOPUS, IAS Conference database of abstracts, and CROI Conference database of abstracts. Searches were done in December 2016 with no time restriction. We fitted random effects (RE) models and used forest plots to display risk ratios (RR) and 95% CIs separately for the linkage to VMMC outcome. The RE model was also used to assess heterogeneity for the linkage to HIV treatment outcome. RESULTS: Of the 1205 citations identified from searches, 48 full text articles were reviewed culminating in nine articles in the final analysis. Five trials investigated the effect of DSFIs on linkage to HIV treatment while four trials investigated linkage to VMMC. Financial incentives improved linkage to HIV treatment in three of the five trials that investigated this outcome. Significant improvements were observed among postpartum women RR 1.26 (95% CI: 1.08; 1.48), among people who inject drugs RR 1.42 (95% CI: 1.09; 1.96), and among people testing at the clinic RR 1.10 (95% CI: 1.07; 1.14). One of the two trials that did not find significant improvement in linkage to ART was among people testing HIV positive in clinics RR 0.96 (95% CI: 0.81; 1.16) while the other was among new HIV positive individuals identified through a community testing study RR 0.82 (95% CI: 0.56; 1.22). We estimate an average 4-fold increase in the uptake of circumcision among HIV negative uncircumcised men from our fitted RE model with overall RR 4.00 (95% CI: 2.17; 7.37). There was negligible heterogeneity in the estimates from the different studies with I-squared = 0.0%; p = 0.923. CONCLUSIONS: Overall, DSFIs appeared to improve linkage for both HIV treatment and VMMC with greater effect for VMMC. Demand-side financial incentives could improve linkage to HIV treatment or VMMC in low- and middle-income countries although uptake by policy makers remains a challenge

HIV self-testing alone or with additional interventions, including financial incentives, and linkage to care or prevention among male partners of antenatal care clinic attendees in Malawi: An adaptive multi-arm, multi-stage cluster randomised trial

Background Conventional HIV testing services have been less comprehensive in reaching men than in reaching women globally, but HIV self-testing (HIVST) appears to be an acceptable alternative. Measurement of linkage to post-test services following HIVST remains the biggest challenge, yet is the biggest driver of cost-effectiveness. We investigated the impact of HIVST alone or with additional interventions on the uptake of testing and linkage to care or prevention among male partners of antenatal care clinic attendees in a novel adaptive trial. Methods and findings An adaptive multi-arm, 2-stage cluster randomised trial was conducted between 8 August 2016 and 30 June 2017, with antenatal care clinic (ANC) days (i.e., clusters of women attending on a single day) as the unit of randomisation. Recruitment was from Ndirande, Bangwe, and Zingwangwa primary health clinics in urban Blantyre, Malawi. Women attending an ANC for the first time for their current pregnancy (regardless of trimester), 18 years and older, with a primary male partner not known to be on ART were enrolled in the trial after giving consent. Randomisation was to either the standard of care (SOC; with a clinic invitation letter to the male partner) or 1 of 5 intervention arms: the first arm provided women with 2 HIVST kits for their partners; the second and third arms provided 2 HIVST kits along with a conditional fixed financial incentive of $3 or$10; the fourth arm provided 2 HIVST kits and a 10% chance of receiving $30 in a lottery; and the fifth arm provided 2 HIVST kits and a phone call reminder for the women’s partners. The primary outcome was the proportion of male partners who were reported to have tested for HIV and linked into care or prevention within 28 days, with referral for antiretroviral therapy (ART) or circumcision accordingly. Women were interviewed at 28 days about partner testing and adverse events. Cluster-level summaries compared each intervention versus SOC using eligible women as the denominator (intention-to-treat). Risk ratios were adjusted for male partner testing history and recruitment clinic. A total of 2,349/3,137 (74.9$3 (geometric mean 40.9%, adjusted risk ratio [aRR] 3.01 [95% CI 1.63–5.57], p < 0.001), HIVST + $10 (51.7$23.73 and $28.08 for the HIVST +$3 and HIVST + $10 arms, respectively. Notable limitations of the trial included the relatively small number of clusters randomised to each arm, proxy reporting of the male partner testing outcome, and being unable to evaluate retention in care. Conclusions In this study, the odds of men’s linkage to care or prevention increased substantially using conditional fixed financial incentives plus partner-delivered HIVST; combinations were potentially affordable

Determinants of crop yield and profit of family farms: evidence from the Senegal River Valley

SUMMARY This paper investigates the determinants of the performance of family farms in Senegal using both production and profit functions. The econometric analysis is based on agricultural inputs and outputs information from a survey of 504 agricultural households, member of a farmer organization in the Saint Louis region in 2009. Our main results indicate that the size of the cultivated plots has a negative effect on crop yields, representing diseconomies of scale. This finding suggests potential for improvements in farm management and organization. We also find that the development of commercialization sectors and loans could boost agricultural inputs. In terms of profitability, our results show that yields and prices play significant and important roles for all crops. An increase in the bargaining power of farmers would be required to increase unit prices and consequently their profits

Child labour prevalence in the cocoa industry in Cote d'Ivoire

  The data set is the one used in the paper "Estimating the prevalence of child labour in the cocoa industry via indirect elicitation methods: A mixed-methods study" by Lepine et al. It contains data collected from 1,741 cocoa producers working in Côte d’Ivoire to estimate whether child labour prevalence could be elicited from parents using indirect elicitation methods. The data set includes child labour prevalence capturing hazardous child labour levels elicited via direct questioning versus using a list experiment and a newly developed nonverbal method called ‘colorbox’. </p

POWER RCT dataset

This dataset contains the survey responses and biomarker data for 3 waves of the POWER RCT titled: "Protecting Women from Economic shocks to fight HIV in Africa (POWER)". It contains 2,909 observations from 1,147 respondents stratified almost equally between women engaged in commercial and transactional sex.The main research hypothesis is that women who engage in transactional and commercial sex in Africa use risky sex as a way to cope for economic shocks. Providing health insurance to themselves and their economic dependents is effective to reduce risky sexual behaviours, and prevent STIs and HIV infection among women and girls who engage in commercial and transactional sex. The general objective of this research is to understand explore the role of economic shocks (e.g.,illness, COVID-19) as a driver of heightened vulnerability of women to HIV in order to inform the design of novel public heath interventions to tackle STIs and HIV. The RCT aims to estimate the effectiveness of health insurance for high-risk women and their economic dependents as a strategy to prevent STI and HIV. The POWER project addresses important gaps in the current literature by answering to the following research questions:- What is the role of economic shocks on STIs and HIV?- How do economic shocks affect STIs and HIV?- What is the effect of health insurance as a risk-coping strategy to reduce risky sexual behaviours, STIs and HIV?</p