title: 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 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 6 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 to 0.04], if they believed it would be "very likely" to pass HIV to their baby if they did not take any HIV drug vs. not (RD, -0.15; 95% CI: -0.32 to 0.02), and if they anticipated that not having money would make it difficult for them to come to the clinic vs. not (RD, 0.12; 95% CI: -0.07 to 0.30). The effect of each of the 3 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 the clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, -0.12; 95% CI: -0.35 to 0.10).
  
  
  CONCLUSIONS
  Our analyses show that cash transfers improve retention in prevention of mother-to-child transmission services mainly by mitigating the negative effect of not having money to come to the clinic.
authors: *Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH; Departments of †Epidemiology; ‡Health Behavior; §Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC; ‖School of Public Health, The University of Kinshasa, Kinshasa, Democratic Republic of Congo; and ¶Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors: Marcel
authors: M
authors: Yotebieng
authors: Kathryn E
authors: KE
authors: Moracco
authors: Harsha
authors: H
authors: Thirumurthy
authors: Andrew
authors: A
authors: Edmonds
authors: Martine
authors: M
authors: Tabala
authors: Bienvenu
authors: B
authors: Kawende
authors: Landry K
authors: LK
authors: Wenzi
authors: Emile W
authors: EW
authors: Okitolonda
authors: Frieda
authors: F
authors: Behets
mesh_terms: D015023:Democratic Republic of the Congo; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D055118:Medication Adherence; D009042:Motivation; D011247:Pregnancy