Conditional Cash Transfers Improve Retention in PMTCT Services by Mitigating the Negative Effect of Not Having Money to Come to the Clinic

Abstract

Objective To elucidate the mechanisms by which a cash incentive intervention increases retention in prevention of mother-to-child transmission (PMTCT) services. Methods We used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo. Perceptual factors associated with loss-to-follow-up (LTFU) through six weeks postpartum were first identified. Then, binomial models were used to assess interactions between LTFU and identified factors, and the cash incentive intervention. Results Participants were less likely to be LTFU if they perceived HIV as a “very serious” health problem for their baby vs. not (risk difference [RD], −0.13; 95% confidence interval [CI], −0.30, 0.04), if they believed it would be “very likely” to pass HIV on to their baby if they did not take any HIV drug vs. not (RD, −0.15; 95% CI, −0.32, 0.02), and if they anticipated that not having money would make it difficult for them to come to clinic vs. not (RD, 0.12; 95% CI, −0.07, 0.30). The effect of each of the three factors on LTFU was antagonistic to that of receiving the cash incentive intervention. The excess risk due to interaction between the cash incentive intervention and the anticipated difficulty of “not having money” to come to clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, −0.12; 95% CI, −0.35, 0.10). Conclusions Our analyses show that cash transfers improve retention in PMTCT services mainly by mitigating the negative effect of not having money to come to the clinic.

HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI‐PMTCT study

“…The issue of high loss‐to‐follow‐up immediately after ART initiation has been at the frontline of PMTCT research, since the start of the option B+ era . This would implicate that women who are at the highest risk for non‐adherence tend to drop‐out the soonest.…”

Role of Temporal Discounting in a Conditional Cash Transfer (CCT) Intervention to Improve Engagement in the Prevention of Mother-to-Child Transmission (PMTCT) Cascade

“…One such source of motivation may be the coverage of transport costs upon arrival for routine clinic visits. In a previous study using the same data, Yotebieng et al found evidence suggesting that CCT improves retention by mitigating the cost of clinic attendance [44]. Among women wishing to attend clinic visits as part of routine prenatal or infant care, but who are unable to do so because of travel di culties, CCT could provide enough money to cover the cost of transport.…”

Role of temporal discounting in a conditional cash transfer (CCT) intervention to improve engagement in the prevention of mother-to-child transmission (PMTCT) cascade

“…One such source of motivation may be the coverage of transport costs upon arrival for routine clinic visits. In a previous study using the same data, Yotebieng et al found evidence suggesting that CCT improves retention by mitigating the cost of clinic attendance [22]. Among women wishing to attend clinic visits as part of routine prenatal or infant care, but who are unable to do so because of travel di culties, CCT could provide enough money to cover the cost of transport.…”