Conditional cash transfers to increase uptake of and retention of PMTCT services

有条件现金转移以增加预防母婴传播服务的使用和保留

• 批准号: 8435107
• 负责人: Marcel Yotebieng
• 金额: $ 39.49万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-25 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8435107
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Affect; Anti-Retroviral Agents; Back; Behavior; Blood specimen; Breast Feeding; CD4 Lymphocyte Count; Caring; Centers for Disease Control and Prevention (U.S.); Child; Clinic; Clinic Visits; Control Groups; Country; Democratic Republic of the Congo; Development; Drug usage; Effectiveness; Emergency Situation; Ensure; Foundations; Funding; Goals; Government; HIV; HIV Infections; HIV Seropositivity; Health; Health behavior; Incentives; Income; Infant; Infant Health; Intervention; Interview; Knowledge; Maternal Health; Medical; Mental Health; Mothers; Nevirapine; Newly Diagnosed; Participant; Patients; Perception; Pharmaceutical Preparations; Population; Postpartum Period; Pregnancy; Pregnant Women; Prevention; Public Health; Public Health Schools; Randomized; Recommendation; Regimen; Risk; Schedule; Scheme; Schools; Services; Severities; Site; Smoking; Structure; Substance abuse problem; Techniques; Testing; Time; Vaccination; Vertical Disease Transmission; Visit; Woman; World Health Organization; behavior change; contingency management; cost; improved; information processing; innovation; payment; pediatric human immunodeficiency virus; pregnant; prevention service; programs; scale up; standard of care; transmission process; treatment program; treatment site; uptake; virtual

DESCRIPTION (provided by applicant): If implemented optimally, recent World Health Organization recommendations can reduce the risk of mother- to-child HIV transmission (MTCT) to less than 5% in breastfeeding populations and less than 2% in non- breastfeeding populations. Successful implementation of prevention of mother-to-child HIV transmission (PMTCT) interventions that maximize maternal health and infant HIV-free survival requires high levels (>95%) of uptake and adherence to a continuum of services also referred to as the PMTCT cascade. Interventions that substantially improve uptake and adherence to the PMTCT cascade are critical for reaching the global goal of virtual elimination of MTCT by 2015. In the past decade, conditional cash transfers (CCTs) have become a widely-used intervention for achieving behavior change, but they have not been applied to the PMTCT setting and little is known about the mechanisms through which CCTs facilitate the adoption of health promoting behaviors. The aims of this study are 1) to test whether small, increasing cash payments to HIV- infected pregnant women, on the condition that they attend all scheduled clinic visits and uptake of services, will increase the proportion of women who receive the most effective antiretroviral (ARV) regimen they are eligible for and deliver at an affiliated maternity, and 2) identify: a) factors that facilitate or inhibit uptake and adherence to PMTCT services, including HIV-infected pregnant women's perception of MTCT risk and the severity of the potential impact of HIV infection on their infants' health; and b) the extent to which identified barriers to PMTCT uptake and adherence were mitigated by the CCT program. The study will be conducted in our PEPFAR/CDC-funded HIV prevention, care, and treatment program in Kinshasa, Democratic Republic of Congo (DRC) which include for PMTCT, a network of 44 maternities, and serving over 50,000 pregnant women. At their first visit between 28 and 32 weeks of gestation, 600, newly diagnosed, HIV-positive pregnant women will be randomized to: 1) the standard of care, or 2) the standard of care plus increasing cash payments, starting at $5 and increasing by $1 each month, trough six-week postpartum. There will be a reset contingency wherein the escalating value of the incentive goes back to its original value ($5) should the mother fail to complete any of the actions required at a specific visit including: attending the monthly scheduled clinic visits, providing a blood sample for CD4 count, uptake of HIV care and treatment if referred, and adhere to prescribed antiretroviral drugs. The study will be conducted in partnership with the DRC Ministry of Health through the national AIDS control program (PNLS), the Catholic Medical Board (BDOM), the DRC Salvation Army, and the Kinshasa School of Public Health. In the DRC, our results will inform the ongoing effort by PEPFAR and the DRC government towards the goal of virtual elimination of pediatric HIV by 2015. If shown to be effective, the contingency management scheme we propose can be easily integrated into other PMTCT programs throughout low and middle income countries. PUBLIC HEALTH RELEVANCE: To inform the ongoing debate over how to ensure that pregnant HIV-infected women and their infants receive vital services for the prevention of mother-to-child HIV transmission (PMTCT), we will test the effectiveness of an escalating scheme of small, conditional cash transfers (CCTs) to increase patient retention and service uptake. Additionally, we will examine how HIV-infected women process information they receive during antenatal care visits and how they perceive vertical transmission risk, in order to better understand how CCTs affect adherence to care. If shown to be effective, the low-cost CCTs we propose can be easily integrated in PMTCT programs throughout other low- and middle-income countries.

描述（由申请人提供）：如果最佳实施，最近的世界卫生组织建议可以将母亲艾滋病毒传播（MTCT）的风险降低到母乳喂养人群不到5％，而非母乳喂养人群的风险不到2％。成功实施预防母亲艾滋病毒传播（PMTCT）干预措施，以最大化孕产妇健康和婴儿艾滋病毒的生存率，需要高水平（> 95％）的吸收和遵守对连续服务的服务也称为PMTCT级联。 Interventions that substantially improve uptake and adherence to the PMTCT cascade are critical for reaching the global goal of virtual elimination of MTCT by 2015. In the past decade, conditional cash transfers (CCTs) have become a widely-used intervention for achieving behavior change, but they have not been applied to the PMTCT setting and little is known about the mechanisms through which CCTs facilitate the adoption of health promoting behaviors.这项研究的目的是1）测试以少量的现金支付给受艾滋病毒感染的孕妇是否参加所有预定的诊所就诊和服务的情况，将增加获得最有效的抗逆转录病毒（ARV）方案的妇女比例，她们有资格在分娩的材料和2）中及其及2）或2）and或2）确定了：A）服务，包括感染HIV的孕妇对MTCT风险的看法以及艾滋病毒感染对婴儿健康的潜在影响的严重性； b）CCT计划减轻了鉴定出对PMTCT摄取和依从性的障碍的程度。该研究将在我们的PEPFAR/CDC资助的预防艾滋病毒，护理和治疗计划中，刚果民主共和国（DRC），其中包括PMTCT，44个产妇的网络以及为50,000多名孕妇服务。在妊娠28至32周之间的第一次访问中，有600周，新诊断为新诊断，HIV阳性孕妇将随机分配到：1）护理标准，或2）护理标准加上现金支付的增加，起价为5美元起，每月增加1美元，每月1美元，槽六周的后果。如果母亲未能完成特定访问时所需的任何动作，则将有一个重置应急，即激励措施的升级价值可以追溯到其原始价值（5美元），包括：参加每月定期的诊所就诊，为CD4计数提供血液样本，以接受HIV护理和治疗，如果提到了HIV护理和治疗，并遵守了处方药物的处方药。该研究将通过国家艾滋病控制计划（PNLS），天主教医疗委员会（BDOR），刚果民主共和党救世军和金沙萨公共卫生学院合作与刚果民主共和国卫生部合作进行。在刚果民主共和国，我们的结果将为Pepfar和刚果民主共和国政府的持续努力提供到2015年虚拟消除小儿艾滋病毒的目标。如果证明是有效的，我们建议的应急管理计划可以轻松地整合到整个低价和中等收入国家的其他PMTCT计划中。 公共卫生相关性：为了告知正在进行的有关如何确保怀孕的HIV感染的妇女及其婴儿为预防母亲艾滋病毒传播（PMTCT）获得重要服务，我们将测试小型，有条件的现金转移者（CCT）升级方案的有效性，以增加患者的重新转移和服务。此外，我们将研究在产前护理访问期间收到的HIV感染妇女处理信息以及他们如何感知垂直传播风险，以便更好地了解CCT如何影响依从性护理。如果证明是有效的，我们建议的低成本CCT可以轻松地集成到其他低收入国家和中等收入国家的PMTCT计划中。