Impact of emergency financial support program on testing demand, SARS-CoV-2 prevalence, and social isolation during COVID-19 outbreak in Brazil: a quasi-experimental study.

Background: Programs offering financial support have been established to mitigate the economic fallout and vulnerabilities arising from the COVID-19 pandemic. Moreover, financial incentives were introduced to promote compliance with social isolation measures, thereby preventing SARS-CoV-2 infections and transmission. However, few low- and middle-income countries have implemented financial aid to alleviate the socio-economic impact of the COVID-19 pandemic. We estimated the association between the Brazilian Emergency Aid (EA) Program and SARS-CoV-2 testing demand, SARS-CoV-2 prevalence, and social isolation levels.

Methods: In this quasi-experimental study, we assessed microdata information from 380,000 individuals surveyed in the COVID-19 National Household Sample Survey (COVID-19 NHSS) between July 1, 2020, and Nov 30, 2020. Individuals meeting the EA eligibility criteria, those who have taken the SARS-CoV-2 test, those diagnosed with COVID-19, and/or those complying with social isolation measures were included. Beneficiaries and non-beneficiaries were matched (1:1) using propensity score matching, combined with the entropy balance technique and inverse probability treatment weighting, considering all relevant socioeconomic and health covariates. We performed logistic regression to compute the monthly average impact of EA benefits on the outcomes above.

Results: We included 171,183 performed tests, 19,218 COVID-19 cases, and individuals' self-response in complying with mild (N = 660,297), moderate (N = 597,159), strict social isolation (N = 149,125), and those who did not constrain social gatherings (N = 1,406,581). EA recipients showed greater testing demand (November; odds ratio [OR] = 1.014, 95% confidence interval [CI]: 1.001-1.026); however, this did not significantly reduce SARS-CoV-2 prevalence. Beneficiaries adhered better to mild isolation from July-September (September; OR: 1.017, 95% CI: 1.007-1.028), with no significant improvement from October-November. EA beneficiaries did not adhere to moderate (July, OR: 0.95, 95% CI: 0.94-0.97; November, OR: 0.83, 95% CI: 0.80-0.86) or strict (July, OR: 0.79, 95% CI: 0.75-0.84; November, OR: 0.77, 95% CI: 0.73-0.81) isolation compared to non-beneficiaries.

Conclusions: Despite the severe COVID-19 situation in Brazil owing to the lack of effective public health policies and government resistance to scientific guidance, being an EA beneficiary was associated with increased testing demand and better adherence to mild social isolation measures.