Economic cost composition by arm and outcomes.

Caregivers of adolescents living with HIV encounter multiple economic and psycho-social challenges which impair their wellbeing and provision of optimal care. Cash transfers combined with short message service (SMS) nudges may address the financial and mental barriers to caregiver wellbeing in sub-Saharan Africa. We examined the preliminary effectiveness and feasibility outcomes of this multipronged approach for improving caregiver wellbeing. We piloted the Caregiver Wellbeing intervention in the eThekwini municipality, KwaZulu-Natal, South Africa. Participants were randomly assigned to one of the following groups: (i) the intervention arm (n = 50) received three cash payments (of ZAR 350, approximately 21 USD), coupled with behaviourally-informed mobile SMS nudges over a 3-month period; (ii) the control arm (n = 50) received a standard SMS encouraging linkage to health services. The primary outcome was change in psychological wellbeing at four-months follow-up. Secondary outcomes were changes in depressive symptoms and caregiver burden scores, recruitment pace, retention, uptake, acceptability and costs. Trial Registraion Number: PACTR202203585402090. The n = 100 caregivers (mean age = 42.3 years, 87% female) enrolled at baseline were recruited within six weeks. Compared to controls, there was a non-significant increase in psychological wellbeing (β = 3.14, p = 0.319). There was a 1.32 unit (p = 0.085) decrease in depressive symptoms and a reduction in caregiver burden (β = -1.28, p = 0.020) in the intervention arm. Participant retention was 85%, with high intervention uptake (95%). Caregivers expressed appreciation for the intervention as the cash component allowed them to fulfil their carer responsibilities and the SMS brought a sense of belonging and self-acceptance. Total societal cost of the intervention was US$13,549, and the incremental cost per increase in wellbeing score was US$1,080. Results suggest a cash transfer plus SMS nudge package, whilst feasible and acceptable, may require longer duration and an economic empowerment component to enhance caregiver wellbeing as part of post-pandemic recovery efforts.

感染人类免疫缺陷病毒（HIV）的青少年照护者面临多重经济与社会心理挑战，这些挑战会损害其自身福祉以及优质照护服务的供给能力。现金补助结合短消息服务（SMS）提醒干预，或可解决撒哈拉以南非洲地区照护者福祉面临的经济与心理障碍。本研究针对该多维度干预手段在改善照护者福祉方面的初步有效性与可行性结局展开评估。

本研究在南非夸祖鲁-纳塔尔省eThekwini自治市开展照护者福祉干预试点。研究对象被随机分配至以下两组：（1）干预组（n=50）：在3个月周期内获得3笔现金补助（每笔350南非兰特，约合21美元），并辅以基于行为学设计的移动SMS提醒干预；（2）对照组（n=50）：仅接收一条鼓励其对接医疗服务的标准SMS短信。

本研究的主要结局指标为随访4个月时的心理福祉变化情况；次要结局指标包括抑郁症状与照护者负担评分的变化、招募进度、留存率、干预参与率、可接受性及相关成本。试验注册编号：PACTR202203585402090。

基线时入组的100名照护者（平均年龄42.3岁，女性占比87%）在6周内完成招募。与对照组相比，干预组的心理福祉虽存在非显著性提升（β=3.14，p=0.319）；抑郁症状评分降低1.32个单位（p=0.085），照护者负担评分亦有所下降（β=-1.28，p=0.020）。研究对象留存率达85%，干预参与率高达95%。照护者对该干预方案表示认可，认为现金补助部分助力其履行照护职责，而SMS提醒则为其带来了归属感与自我接纳感。该干预方案的社会总成本为13549美元，每提升1个福祉评分所需的增量成本为1080美元。

研究结果显示，现金补助结合SMS提醒的干预方案虽具备可行性与可接受性，但要将其作为后疫情时代复苏工作的一部分以改善照护者福祉，或需延长干预周期并加入经济赋权相关模块。