title: Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: a randomised controlled trial.
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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  President's Emergency Plan for AIDS Relief and the National Institute of Health and Child Development.
authors: The Ohio State University, College of Public Health, Division of Epidemiology, Columbus, OH, USA; The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA. Electronic address: yotebieng.2@osu.edu.
authors: Marcel
authors: M
authors: Yotebieng
authors: The University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, NC, USA.
authors: Harsha
authors: H
authors: Thirumurthy
authors: The University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC, USA.
authors: Kathryn E
authors: KE
authors: Moracco
authors: The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
authors: Bienvenu
authors: B
authors: Kawende
authors: The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
authors: Jean Lambert
authors: JL
authors: Chalachala
authors: The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
authors: Landry Kipula
authors: LK
authors: Wenzi
authors: The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA.
authors: Noro Lantoniaina Rosa
authors: NL
authors: Ravelomanana
authors: The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA.
authors: Andrew
authors: A
authors: Edmonds
authors: The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA.
authors: Deidre
authors: D
authors: Thompson
authors: The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo.
authors: Emile W
authors: EW
authors: Okitolonda
authors: The University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA; The University of North Carolina at Chapel Hill, Department of Social Medicine, Chapel Hill, NC, USA.
authors: Frieda
authors: F
authors: Behets
mesh_terms: D000293:Adolescent; D000328:Adult; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D005260:Female; D005378:Financial Support; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009042:Motivation; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*