Empowerment for positive living: Evaluating the impact of a microfinance intervention on clinical, economic, and behavioral outcomes among people living with human immunodeficiency virus (HIV) in Uganda

INTERVENTION: The Empowerment for Positive Living (EPL) cash grant intervention will provide cash transfers of 350,000 Ugandan shillings (approximately $130 USD) to approximately 1500 clients over a two‐year period. The beneficiaries will be active TASO clients, and hence HIV+ individuals, living in two rural areas of Uganda, Masindi and Soroti. Individual clients will be randomly assigned to one of four arms, each containing approximately 500 clients: 1. In the unstructured grant (UG) treatment, clients are told that they have been chosen to receive a cash grant to improve their overall welfare, but they are not given any guidance on how the money should be spent. Recipients learn about enrollment in the program through individual notification, and grants are distributed at a subsequent meeting that will take place at the TASO Masindi and Soroti Centers. 2. In the grant + planning (GP) treatment, recipients are told that they have been chosen to receive a grant to improve their overall welfare, and counselors then follow a script which guides a discussion of ways to budget their money and plan the optimal use of their cash grant, likely temptations and social pressures that might lead them to misuse the money, and strategies making sure the grant is used effectively. One week later, clients complete the second portion of this mental planning component, which revisits their previous discussion and reviews the client?s plan, and then receive the grant. 3. Clients in the pure control (PC) group do not receive a cash grant. They continue to have their regular meetings with TASO counselors throughout the project, but do not receive any infusion of capital. 4. Clients in the control ? expectations (CE) group do not receive a cash grant in the first year of the project, and continue with their regular meetings with TASO counselors. However, they are told that they will be phased in approximately a year later, after the first round of cash grants is completed. The total duration o CONDITION: HIV / AIDS ; Infections and Infestations ; Unspecified human immunodeficiency virus [HIV] disease PRIMARY OUTCOME: 1. Quality of Life will be measured using the culturally adapted version of the Medical Outcomes Study (MOS‐HIV) tool. Two summary scores will be calculated: the physical health summary (PHS) and the mental health summary (MHS) scores.; 2. HIV RNA viral load is a surrogate marker of whether drug treatment is working by suppressing the virus. It is commonly understood as a surrogate of being adherent to treatment and may indicate treatment failure. Viral load will be measured using standard HIV RNA measurement (threshold <400 copies ml).; ; Outcomes measured at baseline and two years later at end line. INCLUSION CRITERIA: 1. Men and women aged = 18 years 2. Current clients at The AIDS Support Organization (TASO) SECONDARY OUTCOME: 1. Household food security: We will measure household access to sufficient nutrition using the Household Hunger Scale, which was developed by the Food and Nutrition Technical Assistance Project (FANTA) project by adapting the nine‐item Household Food Insecurity Access Scale (HFIAS) for cross‐cultural use.; 2. Household income and expenditures: We will collect detailed income and expense information from the respondents every two weeks upon grant receipt, as well as 12 months after grant receipt. ; 3. Savings and asset accumulation: We will assess the rate savings and asset accumulation for each recipient according to amount saved at 12 months after receiving the grant. The tool we will use considers savings in terms of both cash savings and acquired household items, including animals.; 4. Time allocation: Detailed time use data will be collected during the baseline, and every two weeks upon grant receipt, as well as 12 months after grant receipt.; 5. Sexual Behaviour: We will assess sexual behavior using the Joint Clinical Research Centre (JCRC, Uganda) Sexual behaviour questionnaire, developed for use specifically with HIV+ patients. The questionnaire inquires of number and types of sexual partners, condom use with different partners and at the last sexual intercourse respectively in the previous 6 months, as well as disclosure of HIV status to sexual partners. ; 6. CD4 T‐cell changes: We will assess CD4 T‐cell changes, as a function of immune status using TASO clinic attendance and laboratory readings.; 7. Healthcare interruption and retention: We will assess retention in the antioretroviral therapy (ART) program according to whether the patient has attended any TASO clinical appointment in the previous 4 months and survey questions on adherence to medication in the 3 days before the survey occurrence.; 8. Attendance of household children in school: Attendance of eligible children (i.e. all children aged 5‐17) in school programs will be based on a detailed household child roster that will include information on grade completed for each child, current school attendance, and the type of school (government or private) attended.