TY - JOUR
T1 - Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care
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
N1 - Funding Information:
This study was supported by a grant from the President''s Emergency Plan for AIDS Relief (PEPFAR) and the National Institute of Health and Child Development (NIHCD 1R01 HD075171). MY is partially supported by the National Institute of Health (1U01AI096299-01). We are grateful for the participation and time of the mothers and infants in the study, the time and efforts of the personnel of the participating clinics, the technical support of Landry Kiketa and Martine Tabala, the data collection and data entry contributions of Josée Nlandu Babela, Valerie B Chalachala, Fanny Matadi, Espérance Mindia, and Georges Kihuma Nganguli, and the support of the Ohio State University''s, University of North Carolina''s, and Kinshasa School of Public Health''s administrative teams.
Funding Information:
This study was supported by a grant from the President's Emergency Plan for AIDS Relief (PEPFAR) and the National Institute of Health and Child Development (NIHCD 1R01 HD075171). MY is partially supported by the National Institute of Health (1U01AI096299-01). We are grateful for the participation and time of the mothers and infants in the study, the time and efforts of the personnel of the participating clinics, the technical support of Landry Kiketa and Martine Tabala, the data collection and data entry contributions of Josée Nlandu Babela, Valerie B Chalachala, Fanny Matadi, Espérance Mindia, and Georges Kihuma Nganguli, and the support of the Ohio State University's, University of North Carolina's, and Kinshasa School of Public Health's administrative teams.
Publisher Copyright:
© 2016 Elsevier Ltd.
PY - 2016/2/1
Y1 - 2016/2/1
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.
AB - 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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U2 - 10.1016/S2352-3018(15)00247-7
DO - 10.1016/S2352-3018(15)00247-7
M3 - Article
C2 - 26847230
AN - SCOPUS:84958150660
SN - 2352-3018
VL - 3
SP - e85-e93
JO - The Lancet HIV
JF - The Lancet HIV
IS - 2
ER -
