Role of temporal discounting in a conditional cash transfer (CCT) intervention to improve engagement in the prevention of mother-to-child transmission (PMTCT) cascade

Jessica Londeree Saleska,Abigail Norris Turner,Maria F Gallo,Abigail Shoben,Harsha Thirumurthy,Marcel Yotebieng,Noro Lantoniaina Rosa Ravelomanana,Bienvenu Kawende

doi:10.1186/s12889-021-10499-0

Abstract

BackgroundTemporal discounting, the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors. Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of high discount rates on health behaviors.MethodsWith data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo, we used binomial models to assess interactions between discount rates (measured using a delay-discounting task) and the intervention. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services.ResultsThe effect of high discount rates on retention was small, and we did not observe evidence of interaction between high discount rates and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high discount rates on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: − 0.09, 0.44).ConclusionsOur findings provide evidence to support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high rates of temporal discounting.Trial registrationClinicaltrials.gov number NCT01838005, April 23, 2013.

Highlights

Temporal discounting, the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors
A comprehensive description of the parent study methods and results, which showed that the Conditional cash transfer (CCT) intervention increased retention in HIV care but did not improve antiretroviral drugs (ARVs) adherence or viral suppression among those retained in care, has been published previously [25, 32]
We found no or little evidence that receiving CCT modified the effect of high discount rates on retention (IC: − 0.08 (− 0.30, 0.14); Table 3)

Summary

Introduction

The tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of high discount rates on health behaviors. The rapid scale-up of interventions to prevent motherto-child transmission of HIV over the past decade has led to drastic reductions in the number of new HIV-1 infections among children, which fell by an estimated 35% between 2010 and 2017 [1]. This drop is largely attributed to expansions in access to antiretroviral drugs (ARVs) among pregnant and breastfeeding women. The PMTC T cascade includes attendance at regular clinic visits (i.e., retention in care, at a minimum for ARV medication refills), delivery in a health facility, and testing of the HIV-exposed infant at specific post-partum time points (6 weeks, 9 months, and at breastfeeding cessation)

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