Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: A randomised controlled trial

Marcel Yotebieng, Harsha Thirumurthy, Kathryn E. Moracco, Bienvenu Kawende, Jean Lambert Chalachala, Landry Kipula Wenzi, Noro Lantoniaina Rosa Ravelomanana, Andrew Edmonds, Deidre Thompson, Emile W. Okitolonda, Frieda Behets

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission (PMTCT) services in sub-Saharan Africa. We aimed to determine whether small, increasing cash payments, which were conditional on attendance at scheduled clinic visits and receipt of proposed services can increase the proportions of HIV-infected pregnant women who accept available PMTCT services and remain in care. Methods: In this randomised controlled trial, we recruited newly diagnosed HIV-infected women, who were 32 or less weeks pregnant, from 89 antenatal care clinics in Kinshasa, Democratic Republic of Congo, and randomly assigned (1:1) them to either the intervention group or the control group using computer-based randomisation with varying block sizes of four, six, and eight. The intervention group received compensation on the condition that they attended scheduled clinic visits and accepted offered PMTCT services (US$5, plus US$1 increment at every subsequent visit), whereas the control group received usual care. Outcomes assessed included retention in care at 6 weeks' post partum and uptake of PMTCT services, measured by attendance of all scheduled clinic visits and acceptance of proposed services up to 6 weeks' post partum. Analyses were by intention to treat. This trial is registered with ClinicalTrials.org, number NCT01838005. Findings: Between April 18, 2013, and Aug 30, 2014, 612 potential participants were identified, 545 were screened, and 433 were enrolled and randomly assigned; 217 to the control group and 216 to the intervention group. At 6 weeks' post partum, 174 participants in the intervention group (81%) and 157 in the control group (72%) were retained in care (risk ratio [RR] 1·11; 95% CI 1·00-1·24). 146 participants in the intervention group (68%) and 116 in the control group (54%) attended all clinic visits and accepted proposed services (RR 1·26; 95% CI 1·08-1·48). Results were similar after adjustment for marital status, age, and education. Interpretation: Among women with newly diagnosed HIV, small, incremental cash incentives resulted in increased retention along the PMTCT cascade and uptake of available services. The cost-effectiveness of these incentives and their effect on HIV-free survival warrant further investigation. Funding: President's Emergency Plan for AIDS Relief and the National Institute of Health and Child Development.

Original languageEnglish (US)
Pages (from-to)e85-e93
JournalThe Lancet HIV
Volume3
Issue number2
DOIs
StatePublished - Feb 1 2016
Externally publishedYes

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Randomized Controlled Trials
Mothers
HIV
Ambulatory Care
Control Groups
Motivation
Odds Ratio
Democratic Republic of the Congo
Intention to Treat Analysis
Prenatal Care
Africa South of the Sahara
National Institutes of Health (U.S.)
Marital Status
Random Allocation
Child Development
Cost-Benefit Analysis
Pregnant Women
Acquired Immunodeficiency Syndrome
Emergencies
Education

ASJC Scopus subject areas

  • Epidemiology
  • Immunology
  • Infectious Diseases
  • Virology

Cite this

Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care : A randomised controlled trial. / Yotebieng, Marcel; Thirumurthy, Harsha; Moracco, Kathryn E.; Kawende, Bienvenu; Chalachala, Jean Lambert; Wenzi, Landry Kipula; Ravelomanana, Noro Lantoniaina Rosa; Edmonds, Andrew; Thompson, Deidre; Okitolonda, Emile W.; Behets, Frieda.

In: The Lancet HIV, Vol. 3, No. 2, 01.02.2016, p. e85-e93.

Research output: Contribution to journalArticle

Yotebieng, M, Thirumurthy, H, Moracco, KE, Kawende, B, Chalachala, JL, Wenzi, LK, Ravelomanana, NLR, Edmonds, A, Thompson, D, Okitolonda, EW & Behets, F 2016, 'Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: A randomised controlled trial', The Lancet HIV, vol. 3, no. 2, pp. e85-e93. https://doi.org/10.1016/S2352-3018(15)00247-7
Yotebieng, Marcel ; Thirumurthy, Harsha ; Moracco, Kathryn E. ; Kawende, Bienvenu ; Chalachala, Jean Lambert ; Wenzi, Landry Kipula ; Ravelomanana, Noro Lantoniaina Rosa ; Edmonds, Andrew ; Thompson, Deidre ; Okitolonda, Emile W. ; Behets, Frieda. / Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care : A randomised controlled trial. In: The Lancet HIV. 2016 ; Vol. 3, No. 2. pp. e85-e93.
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T2 - A randomised controlled trial

AU - Yotebieng, Marcel

AU - Thirumurthy, Harsha

AU - Moracco, Kathryn E.

AU - Kawende, Bienvenu

AU - Chalachala, Jean Lambert

AU - Wenzi, Landry Kipula

AU - Ravelomanana, Noro Lantoniaina Rosa

AU - Edmonds, Andrew

AU - Thompson, Deidre

AU - Okitolonda, Emile W.

AU - Behets, Frieda

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N2 - Background: Novel strategies are needed to increase retention in and uptake of prevention of mother-to-child HIV transmission (PMTCT) services in sub-Saharan Africa. We aimed to determine whether small, increasing cash payments, which were conditional on attendance at scheduled clinic visits and receipt of proposed services can increase the proportions of HIV-infected pregnant women who accept available PMTCT services and remain in care. Methods: In this randomised controlled trial, we recruited newly diagnosed HIV-infected women, who were 32 or less weeks pregnant, from 89 antenatal care clinics in Kinshasa, Democratic Republic of Congo, and randomly assigned (1:1) them to either the intervention group or the control group using computer-based randomisation with varying block sizes of four, six, and eight. The intervention group received compensation on the condition that they attended scheduled clinic visits and accepted offered PMTCT services (US$5, plus US$1 increment at every subsequent visit), whereas the control group received usual care. Outcomes assessed included retention in care at 6 weeks' post partum and uptake of PMTCT services, measured by attendance of all scheduled clinic visits and acceptance of proposed services up to 6 weeks' post partum. Analyses were by intention to treat. This trial is registered with ClinicalTrials.org, number NCT01838005. Findings: Between April 18, 2013, and Aug 30, 2014, 612 potential participants were identified, 545 were screened, and 433 were enrolled and randomly assigned; 217 to the control group and 216 to the intervention group. At 6 weeks' post partum, 174 participants in the intervention group (81%) and 157 in the control group (72%) were retained in care (risk ratio [RR] 1·11; 95% CI 1·00-1·24). 146 participants in the intervention group (68%) and 116 in the control group (54%) attended all clinic visits and accepted proposed services (RR 1·26; 95% CI 1·08-1·48). Results were similar after adjustment for marital status, age, and education. Interpretation: Among women with newly diagnosed HIV, small, incremental cash incentives resulted in increased retention along the PMTCT cascade and uptake of available services. The cost-effectiveness of these incentives and their effect on HIV-free survival warrant further investigation. Funding: President's Emergency Plan for AIDS Relief and the National Institute of Health and Child Development.

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