human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : It is not known whether cumulative ‘ cash plus care ’ interventions can reduce  adolescent HIV-infection risks in sub-Saharan Africa . This study investigated whether parental AIDS and other environmental adversities increase  adolescent HIV-risk behaviour  and whether social protection provision of ‘ cash ’ or integrated ‘ cash plus care ’ reduces HIV-risk behaviour . Design : A prospect i ve observational study with r and om sampling ( < 2.5 % baseline refusal , 1-year follow-up , 96.8 % retention ) . Methods : Three thous and five hundred and fifteen 10–18 year-olds ( 56.7 % girls ) were interviewed in South Africa between 2009–2010 and 2011–2012 . All homes with a resident adolescent were sample d , within r and omly selected census areas in two urban and two rural districts in two provinces . Measures included potential environmental risks ( e.g. parental HIV/AIDS , poverty ) , social protection : receipt of cash/food support ( e.g. child grants , school feeding ) , care ( e.g. positive parenting ) and HIV-risk behaviours ( e.g. unprotected sex ) . Analyses used logistic regression . Results : Cash alone was associated with reduced HIV risk for girls [ odds ratio ( OR ) 0.63 ; 95 % confidence interval ( 95 % CI ) 0.44–0.91 , P = 0.02 ] but not for boys . Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes ( girls OR 0.55 ; 95 % CI 0.35–0.85 , P = 0.007 ; boys OR 0.50 ; 95 % CI 0.31–0.82 , P = 0.005 ) , compared with no support and controlling for confounders . Follow-up HIV-risk behaviour was reduced from 41 to 15 % for girls and from 42 to 17 % for boys . Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour , but were less likely to access integrated social protection . Conclusion : Integrated cash plus care reduces  male and female adolescent HIV-risk behaviours . Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa Introduction The objective of this article is to present the rationale and baseline results for a r and omized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection ( STI ) risk among male sex workers ( MSWs ) in Mexico City . Methods Participants ( n=267 ) were tested and treated for STIs ( chlamydia , gonorrhoea , syphilis and HIV ) and viral hepatitis ( hepatitis B and C ) , received HIV and STI prevention education  and were r and omized into four groups : ( 1 ) control , ( 2 ) medium conditional incentive ( $ 50/six months ) , ( 3 ) high conditional incentive ( $ 75/six months ) and ( 4 ) unconditional incentive ( $ 50/six months ) . In the conditional arms , incentives were contingent upon testing free of new curable STIs ( chlamydia , gonorrhoea and syphilis ) at follow-up assessment s. Results Participants ’ mean age was 25 years ; 8 % were homeless or lived in a shelter , 16 % were unemployed and 21 % lived in Mexico City less than 5 years . At baseline , 38 % were living with HIV , and 32 % tested positive for viral hepatitis or at least one STI ( other than HIV ) .  Participants had a mean of five male clients in the previous week ; 18 % reported condomless sex  with their last client . For 37 % , sex work was their main occupation and was conducted mainly on the streets ( 51 % ) or in bars/discotheques ( 24 % ) and hotels ( 24 % ) . The average price for a sex transaction was $ 25 with a 35 % higher payment for condomless sex . Conclusions The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs , given the market-based inducements for unprotected sex . This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on  adolescent transitions to adulthood in re source poor setting s , however existing research is typically from small scale programs in diverse geographic and cultural setting s. We provide estimates of the impact of a national unconditional cash transfer program , the Kenya Cash Transfer for Orphans and Vulnerable Children  , on pregnancy and early marriage among females aged 12 to 24 , four years after program initiation . The evaluation was design ed as a clustered r and omized controlled trial and ran from 2007 to 2011 , capitalizing on the existence of a control group , which was delayed entry to the program due to budget constraints . Findings indicate that , among 1549 females included in the study , while the program reduced the likelihood of pregnancy by five percentage points , there was no significant impact on likelihood of early marriage . Program impacts on pregnancy appear to work through increasing the enrollment of young women in school , financial stability of the household and delayed age at first sex . The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa , suggesting a degree of generalizability of the results reported here . Although the objective of the program is primarily poverty alleviation , it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa OBJECTIVE The primary goal was to examine whether Malawi Social Cash Transfer Pilot Scheme , initially implemented in a rural district in central Malawi , improved health outcomes for children aged 6 - 17 . Secondary goals were to examine the effects of individual child- ( orphan status and gender ) and household-level factors ( number of working-age adults and sick adults ) on health outcomes . Another secondary goal was to examine whether orphan status modified the cash transfer effect on health outcomes . METHODS This multilevel study used panel data collected in 2007 - 08 from a r and omized controlled evaluation study of phase one of the programme . The analyses included 1197 children aged 6 - 17 in 486 households . The four outcomes of interest were : illness in the past month , illness that stopped normal activities in the past month , missing school due to illness or injury in the past month and health care use for worst illness in the past year . FINDINGS Approximately two-thirds of children in cash transfer eligible households were orphans . Compared with children in non-beneficiary households , those in beneficiary households had a 37 % lower odds of child illness ( P<0.05 ) , 42 % lower odds of illness that stopped normal activities ( P<0.01 ) and substantially higher odds of utilizing health services for a serious illness ( odds ratio=10.98 ; P<0.01 ) . An increase in the household number of working-age adults was associated with 34 % lower odds of child illness ( P<0.01 ) . An increase in the household number of sick adults increased the odds of child illness by 97 % ( P<0.01 ) and serious illness by 49 % ( P<0.01 ) . No statistically significant differences were observed by orphan status and child 's gender . Consistent differential programme effects by orphan status were not observed . CONCLUSION Unconditional cash transfer programmes to poor households have the potential to improve health outcomes for all vulnerable children aged 6 - 17 Background Unconditional and conditional cash transfer programmes ( UCT and CCT ) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS ( OVC ) . We address the gap in current underst and ing about the extent to which household-based cash transfers differentially impact individual children ’s outcomes , according to risk or protective factors such as orphan status and household assets . Methods Data were obtained from a cluster-r and omised controlled trial in eastern Zimbabwe , with r and om assignment to three study arms – UCT , CCT or control . The sample included 5,331 children ages 6 - 17 from 1,697 households . Generalized linear mixed models were specified to predict OVC health vulnerability ( child chronic illness and disability ) and social protection ( birth registration and 90 % school attendance ) . Models included child-level risk factors ( age , orphan status ) ; household risk factors ( adults with chronic illnesses and disabilities , greater household size ) ; and household protective factors ( including asset-holding ) . Interactions were systematic ally tested . Results Orphan status was associated with decreased likelihood for birth registration , and paternal orphans and children for whom both parents ’ survival status was unknown were less likely to attend school . In the UCT arm , paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans . Effects of study arms on outcomes were not moderated by any other risk or protective factors . High household asset-holding was associated with decreased likelihood of child ’s chronic illness and increased birth registration and school attendance , but household assets did not moderate the effects of cash transfers on risk or protective factors . Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based setting s. UCT and CCT each produced direct effects on children ’s social protection which are not moderated by other child- and household-level risk factors , but orphans are less likely to attend school or obtain birth registration . The effects of UCT and CCT are not moderated by asset-holding , but greater household assets predict greater social protection outcomes . Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children . These efforts might include caregiver education , and additional incentives based on efforts made specifically for orphaned children Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT 
    Output:
    
agent
The evidence was uncertain for whether UCTs impacted livestock ownership , extreme poverty , participation in child labour , adult employment or parenting quality .
This body of evidence suggests that unconditional cash transfers ( UCTs ) may not impact a summary measure of health service use in children and adults in LMICs .
However , UCTs probably or may improve some health outcomes ( i.e. the likelihood of having had any illness , the likelihood of having been food secure , and the level of dietary diversity ) , one social determinant of health ( i.e. the likelihood of attending school ) , and healthcare expenditure .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : It is not known whether cumulative ‘ cash plus care ’ interventions can reduce  adolescent HIV-infection risks in sub-Saharan Africa . This study investigated whether parental AIDS and other environmental adversities increase  adolescent HIV-risk behaviour  and whether social protection provision of ‘ cash ’ or integrated ‘ cash plus care ’ reduces HIV-risk behaviour . Design : A prospect i ve observational study with r and om sampling ( < 2.5 % baseline refusal , 1-year follow-up , 96.8 % retention ) . Methods : Three thous and five hundred and fifteen 10–18 year-olds ( 56.7 % girls ) were interviewed in South Africa between 2009–2010 and 2011–2012 . All homes with a resident adolescent were sample d , within r and omly selected census areas in two urban and two rural districts in two provinces . Measures included potential environmental risks ( e.g. parental HIV/AIDS , poverty ) , social protection : receipt of cash/food support ( e.g. child grants , school feeding ) , care ( e.g. positive parenting ) and HIV-risk behaviours ( e.g. unprotected sex ) . Analyses used logistic regression . Results : Cash alone was associated with reduced HIV risk for girls [ odds ratio ( OR ) 0.63 ; 95 % confidence interval ( 95 % CI ) 0.44–0.91 , P = 0.02 ] but not for boys . Integrated cash plus care was associated with halved HIV-risk behaviour incidence for both sexes ( girls OR 0.55 ; 95 % CI 0.35–0.85 , P = 0.007 ; boys OR 0.50 ; 95 % CI 0.31–0.82 , P = 0.005 ) , compared with no support and controlling for confounders . Follow-up HIV-risk behaviour was reduced from 41 to 15 % for girls and from 42 to 17 % for boys . Girls in AIDS-affected families and informal-dwelling boys had higher HIV-risk behaviour , but were less likely to access integrated social protection . Conclusion : Integrated cash plus care reduces  male and female adolescent HIV-risk behaviours . Increasing adolescent access to social protection may be an effective HIV prevention strategy in Sub-Saharan Africa Introduction The objective of this article is to present the rationale and baseline results for a r and omized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection ( STI ) risk among male sex workers ( MSWs ) in Mexico City . Methods Participants ( n=267 ) were tested and treated for STIs ( chlamydia , gonorrhoea , syphilis and HIV ) and viral hepatitis ( hepatitis B and C ) , received HIV and STI prevention education  and were r and omized into four groups : ( 1 ) control , ( 2 ) medium conditional incentive ( $ 50/six months ) , ( 3 ) high conditional incentive ( $ 75/six months ) and ( 4 ) unconditional incentive ( $ 50/six months ) . In the conditional arms , incentives were contingent upon testing free of new curable STIs ( chlamydia , gonorrhoea and syphilis ) at follow-up assessment s. Results Participants ’ mean age was 25 years ; 8 % were homeless or lived in a shelter , 16 % were unemployed and 21 % lived in Mexico City less than 5 years . At baseline , 38 % were living with HIV , and 32 % tested positive for viral hepatitis or at least one STI ( other than HIV ) .  Participants had a mean of five male clients in the previous week ; 18 % reported condomless sex  with their last client . For 37 % , sex work was their main occupation and was conducted mainly on the streets ( 51 % ) or in bars/discotheques ( 24 % ) and hotels ( 24 % ) . The average price for a sex transaction was $ 25 with a 35 % higher payment for condomless sex . Conclusions The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs , given the market-based inducements for unprotected sex . This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts There is promising evidence that poverty-targeted cash transfer programs can have positive impacts on  adolescent transitions to adulthood in re source poor setting s , however existing research is typically from small scale programs in diverse geographic and cultural setting s. We provide estimates of the impact of a national unconditional cash transfer program , the Kenya Cash Transfer for Orphans and Vulnerable Children  , on pregnancy and early marriage among females aged 12 to 24 , four years after program initiation . The evaluation was design ed as a clustered r and omized controlled trial and ran from 2007 to 2011 , capitalizing on the existence of a control group , which was delayed entry to the program due to budget constraints . Findings indicate that , among 1549 females included in the study , while the program reduced the likelihood of pregnancy by five percentage points , there was no significant impact on likelihood of early marriage . Program impacts on pregnancy appear to work through increasing the enrollment of young women in school , financial stability of the household and delayed age at first sex . The Kenyan program is similar in design to most other major national cash transfer programs in Eastern and Southern Africa , suggesting a degree of generalizability of the results reported here . Although the objective of the program is primarily poverty alleviation , it appears to have an important impact on facilitating the successful transition of adolescent girls into adulthood The aim of this study is to assess whether the Government of Kenya 's Cash Transfer for Orphans and Vulnerable Children ( Kenya CT-OVC ) can reduce the risk of HIV among young people by postponing sexual debut . The program provides an unconditional transfer of US$ 20 per month directly to the main caregiver in the household . An evaluation of the program was implemented in 2007–2009 in seven districts . Fourteen Locations were r and omly assigned to receive the program and fourteen were assigned to a control arm . A sample of households was enrolled in the evaluation in 2007 . We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age . We used logistic regression , adjusted for the respondent 's age , sex and relationship to caregiver , the age , sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline , to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program . Our results , adjusted for these covariates , show that the program reduced the odds of sexual debut by 31 percent . There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use , number of partners and transactional sex . Since the CT-OVC provides cash to the caregiver and not to the child , and there are no explicit conditions associated with receipt , these impacts are indirect , and may have been achieved by keeping young people in school . Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa OBJECTIVE The primary goal was to examine whether Malawi Social Cash Transfer Pilot Scheme , initially implemented in a rural district in central Malawi , improved health outcomes for children aged 6 - 17 . Secondary goals were to examine the effects of individual child- ( orphan status and gender ) and household-level factors ( number of working-age adults and sick adults ) on health outcomes . Another secondary goal was to examine whether orphan status modified the cash transfer effect on health outcomes . METHODS This multilevel study used panel data collected in 2007 - 08 from a r and omized controlled evaluation study of phase one of the programme . The analyses included 1197 children aged 6 - 17 in 486 households . The four outcomes of interest were : illness in the past month , illness that stopped normal activities in the past month , missing school due to illness or injury in the past month and health care use for worst illness in the past year . FINDINGS Approximately two-thirds of children in cash transfer eligible households were orphans . Compared with children in non-beneficiary households , those in beneficiary households had a 37 % lower odds of child illness ( P<0.05 ) , 42 % lower odds of illness that stopped normal activities ( P<0.01 ) and substantially higher odds of utilizing health services for a serious illness ( odds ratio=10.98 ; P<0.01 ) . An increase in the household number of working-age adults was associated with 34 % lower odds of child illness ( P<0.01 ) . An increase in the household number of sick adults increased the odds of child illness by 97 % ( P<0.01 ) and serious illness by 49 % ( P<0.01 ) . No statistically significant differences were observed by orphan status and child 's gender . Consistent differential programme effects by orphan status were not observed . CONCLUSION Unconditional cash transfer programmes to poor households have the potential to improve health outcomes for all vulnerable children aged 6 - 17 Background Unconditional and conditional cash transfer programmes ( UCT and CCT ) show potential to improve the well-being of orphans and other children made vulnerable by HIV/AIDS ( OVC ) . We address the gap in current underst and ing about the extent to which household-based cash transfers differentially impact individual children ’s outcomes , according to risk or protective factors such as orphan status and household assets . Methods Data were obtained from a cluster-r and omised controlled trial in eastern Zimbabwe , with r and om assignment to three study arms – UCT , CCT or control . The sample included 5,331 children ages 6 - 17 from 1,697 households . Generalized linear mixed models were specified to predict OVC health vulnerability ( child chronic illness and disability ) and social protection ( birth registration and 90 % school attendance ) . Models included child-level risk factors ( age , orphan status ) ; household risk factors ( adults with chronic illnesses and disabilities , greater household size ) ; and household protective factors ( including asset-holding ) . Interactions were systematic ally tested . Results Orphan status was associated with decreased likelihood for birth registration , and paternal orphans and children for whom both parents ’ survival status was unknown were less likely to attend school . In the UCT arm , paternal orphans fared better in likelihood of birth registration compared with non-paternal orphans . Effects of study arms on outcomes were not moderated by any other risk or protective factors . High household asset-holding was associated with decreased likelihood of child ’s chronic illness and increased birth registration and school attendance , but household assets did not moderate the effects of cash transfers on risk or protective factors . Conclusion Orphaned children are at higher risk for poor social protection outcomes even when cared for in family-based setting s. UCT and CCT each produced direct effects on children ’s social protection which are not moderated by other child- and household-level risk factors , but orphans are less likely to attend school or obtain birth registration . The effects of UCT and CCT are not moderated by asset-holding , but greater household assets predict greater social protection outcomes . Intervention efforts need to focus on ameliorating the additional risk burden carried by orphaned children . These efforts might include caregiver education , and additional incentives based on efforts made specifically for orphaned children Summary Background Cash-transfer programmes can improve the wellbeing of vulnerable children , but few studies have rigorously assessed their effectiveness in sub-Saharan Africa . We investigated the effects of unconditional cash transfers ( UCTs ) and conditional cash transfers ( CCTs ) on birth registration , vaccination uptake , and school attendance in children in Zimbabwe . Methods We did a matched , cluster-r and omised controlled trial in ten sites in Manical and , Zimbabwe . We divided each study site into three clusters . After a baseline survey between July , and September , 2009 , clusters in each site were r and omly assigned to UCT , CCT , or control , by drawing of lots from a hat . Eligible households contained children younger than 18 years and satisfied at least one other criteria : head of household was younger than 18 years ; household cared for at least one orphan younger than 18 years , a disabled person , or an individual who was chronically ill ; or household was in poorest wealth quintile . Between January , 2010 , and January , 2011 , households in UCT clusters collected payments every 2 months . Households in CCT clusters could receive the same amount but were monitored for compliance with several conditions related to child wellbeing . Eligible households in all clusters , including control clusters , had access to parenting skills classes and received maize seed and fertiliser in December , 2009 , and August , 2010 . Households and individuals delivering the intervention were not masked , but data analysts were . The primary endpoints were proportion of children younger than 5 years with a birth certificate , proportion younger than 5 years with up-to- date vaccinations , and proportion aged 6–12 years attending school at least 80 % of the time . This trial is registered with Clinical Trials.gov , number NCT00966849 . Findings 1199 eligible households were allocated to the control group , 1525 to the UCT group , and 1319 to the CCT group . Compared with control clusters , the proportion of children aged 0–4 years with birth certificates had increased by 1·5 % ( 95 % CI −7·1 to 10·1 ) in the UCT group and by 16·4 % ( 7·8–25·0 ) in the CCT group by the end of the intervention period . The proportions of children aged 0–4 years with complete vaccination records was 3·1 % ( −3·8 to 9·9 ) greater in the UCT 
    Output:
    