CASH CARE FOR ADOLESCENT HIV RISK REDUCTION in

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CASH + CARE FOR ADOLESCENT HIV RISK REDUCTION in DREAMS, Global Fund, 4 Children,

CASH + CARE FOR ADOLESCENT HIV RISK REDUCTION in DREAMS, Global Fund, 4 Children, UNICEF and INSPIRE: CLUSTER RCT OF PARENTING FOR LIFELONG HEALTH L. Cluver, F. Meinck, J. Doubt, C Ward, C Lombard, Y Shenderovich, J Steinert, R Herrero Romero, S Medley, A Redfern, N Salah, S De Stone, L Ncobo, J Lachman, S Tsoanyane, H Loening, J Byrne, L Sherr, M Casale, F Gardner, C Wittesdale, R Catanho, S Hoeksma, C Mikton, A Butchart, J van der Wal, K Nocuza , M Pancoast, M Danisa, I Wessels, N Mukadah.

2016 -18 Pragmatic Cluster RCT, Rural South Africa. N=1100 Reducing violence/economic strengthening 2015 Pre-post

2016 -18 Pragmatic Cluster RCT, Rural South Africa. N=1100 Reducing violence/economic strengthening 2015 Pre-post test N=230 Monitoring and praising teens Family problem-solving Family budgeting and saving Safety planning 2014 Pre-post pilot N=60 2013 Community consultation N=150 2012 Systematic review Local community, trained by local NGO Village halls, churches, under trees (14 weeks) 40 villages & urban sites Stratified cluster-randomised, 9 m follow-up

Impacts on structural drivers of adolescent HIV Positive intervention effects IRR/d (95% CI) Less

Impacts on structural drivers of adolescent HIV Positive intervention effects IRR/d (95% CI) Less violence IRR. 55 (. 4, . 75)*** More positive parenting d. 25 (. 03, . 47)* More involved parenting d. 86 (. 64, 1. 1)*** Less poor supervision d-. 05 (-. 7, -. 03)*** Less corporal punishment d. -46 (-. 7, -. 24)*** Less depression (carer) d-. 33 (-. 5, -. 11)** Less parenting stress d-. 37 (-. 6, -. 15)*** Less alcohol/drug use (carer) IRR. 67 (. 49 -99)* No intervention effects Less alcohol/drug use (teen) IRR. 55 (. 33 -93)* Neglect More social support (carer) d. 31 (. 09 -. 52)** Inconsistent discipline More planning to protect teens in the community d. 48 (. 24 -. 72)*** Depression (adolescent) Less shortfalls of food d-. 62 (-. 8 -. 40)*** More family savings d. 31 (. 09 -. 53)** Negative effects None Behavior problems Community violence exposure Cluver, L, Meinck, F, Steinert, J, et al (2018) BMJ Global Health.

Integration of HIV & violence prevention programming Cameroon Cote D’Ivoire DRC Haiti India Kenya

Integration of HIV & violence prevention programming Cameroon Cote D’Ivoire DRC Haiti India Kenya Lesotho Malawi Nigeria Philippines South Africa South Sudan Swaziland Tanzania Thailand Uganda Zimbabwe

Thank you.

Thank you.