Yotebieng, M., Moracco, K., Thirumurthy, H., et al. Journal of Acquired Immune Deficiency Syndromes (February 2017), 74(2)150–157, doi:10.1097/QAI.0000000000001219.
This study examined the mechanisms by which a cash incentive intervention increased retention in the prevention of mother-to-child transmission (PMTCT) programs. It used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo (2013–2014) of 433 newly diagnosed HIV-positive women who received either the standard of care or the standard of care plus small and increasing payments (starting at USD$5 and increasing by $1 under various conditions (i.e., that the woman attended clinic visits; accepted a referral for antiretroviral therapy [ART]; delivered in a facility; and provided a blood sample at six weeks postpartum for early infant diagnosis). Results showed that better knowledge of PMTCT and a greater understanding of and belief in the effectiveness of ART were positively associated with higher adherence to PMTCT services. They also indicated that cash transfers may improve retention in PMTCT services by mitigating the barrier of not having money to come to the facility. The authors noted that the minimum financial incentive proposed should be at least equal to the cost of attending clinic visits. They concluded that interventions that combine sufficient cash incentives to retain pregnant women who are likely to be lost to follow-up with education programs to improve understanding of HIV risk may achieve sustained retention.