Conditional cash transfers to prevent mother-to-child transmission in low facility-delivery settings: evidence from a randomised controlled trial in Nigeria

Jenny X Liu, Jennifer Shen, Nicholas Wilson, Svetha Janumpalli, Patrick Stadler, Nancy Padian, Jenny X Liu, Jennifer Shen, Nicholas Wilson, Svetha Janumpalli, Patrick Stadler, Nancy Padian

Abstract

Background: Nigeria suffers from the highest burden of mother-to-child transmission worldwide. To increase retention in care and prevention programmes, we piloted and evaluated a conditional cash transfer (CCT) programme for preventing mother-to-child transmission (PMTCT) in Akwa Ibom, Nigeria.

Methods: In a randomised controlled trial, pregnant women testing positive for HIV during antenatal care registration at three public hospitals were randomised to one of two study arms: (1) offered enrolment into the CCT programme or (2) continue in standard care for (PMTCT). In the CCT programme, women could receive a compensation package totaling 33,300 Naira (~US$114) for enroling, delivering at the facility, and obtaining a newborn early infant diagnosis (EID) test. The intent-to-treat (ITT) and per protocol (PP) effects of the programme on the primary outcomes of facility delivery and EID testing and on the secondary outcome of nevirapine administration were estimated with logistic regressions.

Results: From August 1, 2015 to April 19, 2017, 554 pregnant women tested positive for HIV; 273 were randomised to standard care and 281 were offered enrolment into the CCT intervention. Women offered the CCT programme were more likely to give birth at the facility (n = 109/263; 41.4%) compared to women in standard care (n = 80/254; 31.5%), an absolute difference of 9.9% (OR = 1.54, 95% CI: 1.07-2.21, p = 0.019). For EID testing there was an absolute difference of 12.8% between those offered the CCT intervention (n = 69/263; 26.2%) and those in standard care (n = 34/254; 13.4%; OR = 2.30, 95% CI 1.46-3.62, p = 0.000). PP results show larger differences for both facility deliveries (16.7% absolute difference; OR = 2.02, 95% CI 1.38-2.98, p = 0.000) and EID testing (18.9% absolute difference; OR = 3.09, 95% CI 1.93-4.94, p = 0.000) among intervention enrolees. Over 86% of the facility-delivered newborns received nevirapine, and ITT and PP estimates were similar to those for facility deliveries.

Conclusions: Results show that CCTs improved the likelihood of HIV-positive women giving birth at a facility, of nevirapine being administered to their newborn, and of undergoing EID testing in Akwa Ibom, Nigeria. Effects are especially large among those who agreed to participate in the CCT intervention.

Trial registration: ClinicalTrials.gov NCT02447159 , May 18, 2015.

Keywords: Conditional cash transfers (CCT); Facility delivery; HIV/AIDS; Nigeria; Prevention of mother-to-child transmission (PMTCT).

Conflict of interest statement

Ethics approval and consent to participate

The institutional review boards (IRBs) at the Akwa Ibom State Ministry of Health (Reference# MH/PRS/99/V.V1/259), Reed College (IRB No. 2015-Su3), and the University of California, San Francisco (Reference# 136540) approved the study protocol and procedures. Use of de-identified patient data collected from hospital records was exempted from informed consent requirements. All women randomized to the CCT intervention arm and agreed to participate in the CCT programme provided written informed consent to be surveyed during enrolment for for their de-identified CCT programme data to be used in the study analysis.

Consent for publication

Not applicable.

Competing interests

SJ and PS are the CEO and CSO, respectively, of New Incentives, a US-based nonprofit committed to implementing health-related cash transfer programmes to save lives in developing countries. Operating in Nigeria, New Incentives gives women with high-risk pregnancies, including HIV-positive women, conditional cash transfers for retention in facility-based care.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Trial profile
Fig. 2
Fig. 2
Percentage of babies delivered at the facility among women enroled in the conditional cash transfer programme. Notes: Differences tested using logistic regression controlling for recruitment site. Pregnancy number outcome restricted to mothers who have previously given birth
Fig. 3
Fig. 3
Percentage of facility-delivered babies with EID testing among women enroled in the conditional cash transfer programme. Notes: Differences tested using logistic regression controlling for recruitment site. Pregnancy number outcome restricted to mothers who have previously given birth

References

    1. Liu L, Oza S, Hogan D, Perin J, Rudan I, Lawn JE, et al. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet. 2015;385:430–440. doi: 10.1016/S0140-6736(14)61698-6.
    1. WHO | Mother-to-child transmission of HIV [Internet]. WHO. [cited 2017 Jan 3]. Available from: . Accessed 3 Jan 2017.
    1. UNAIDS. The Gap Report 2014: Adolescent Girls and Young Women [Internet]. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS (UNAIDS); 2014. Report No.: JC2656. Available from: . Accessed 3 Jan 2017.
    1. Padian NS, Holmes CB, McCoy SI, Lyerla R, Bouey PD, Goosby EP. Implementation science for the US Presidentʼs emergency plan for AIDS relief (PEPFAR) JAIDS J Acquir Immune Defic Syndr. 2011;56:199–203. doi: 10.1097/QAI.0b013e31820bb448.
    1. UNICEF. Nigeria country Programme document 2014–2017 [internet]. UNICEF; 2013. Available from: . Accessed 3 Jan 2017.
    1. National Agency for the Control of AIDS (NACA). End-of-term desk review report of the 2010-2015 National HIV/AIDS strategic plan [internet]. 2015 Jul. Available from: . Accessed 7 Jan 2019.
    1. Anígilájé EA, Ageda BR, Nweke NO. Barriers to uptake of prevention of mother-to-child transmission of HIV services among mothers of vertically infected HIV-seropositive infants in Makurdi, Nigeria. Patient Prefer Adherence. 2016;10:57–72. doi: 10.2147/PPA.S87228.
    1. Hembah-Hilekaan SK, Swende TZ, Bito TT. Knowledge, attitudes and barriers towards prevention of mother-to-child transmission of HIV among women attending antenatal clinics in Uyam District of Zaki-Biam in Benue state, Nigeria : original research article. Afr J Reprod Health. 2012;16:27–34.
    1. National Agency for the Control of AIDS (NACA). Global AIDS Response Country Progress Report: Nigeria GARPR 2012 [Internet]. Abuja, Nigeria: Federal Republic of Nigeria; 2012. Available from: . Accessed 7 Jan 2019.
    1. World Development Indicators [Internet]. 2016 [cited 2017 Oct 4]. Available from: . Accessed 4 Oct 2017.
    1. Markson J, Umoh A. Evaluation of PMTCT programme implementation in general hospital, Iquita Oron, Akwa Ibom state, Nigeria. Ibom Med J. 2013;6:5–15.
    1. Nassali M, Nakanjako D, Kyabayinze D, Beyeza J, Okoth A, Mutyaba T. Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program. AIDS Care. 2009;21:1124–1131. doi: 10.1080/09540120802707467.
    1. Chinkonde JR, Sundby J, Martinson F. The prevention of mother-to-child HIV transmission programme in Lilongwe, Malawi: why do so many women drop out. Reprod Health Matters. 2009;17:143–151. doi: 10.1016/S0968-8080(09)33440-0.
    1. Abubakar A, Van Baar A, Fischer R, Bomu G, Gona JK, Newton CR. Socio-cultural determinants of health-seeking behaviour on the Kenyan coast: a qualitative study. PLoS One. 2013;8:e71998. doi: 10.1371/journal.pone.0071998.
    1. MO hI, Grede N, de Pee S, Bloem M. Economic and Social Factors are Some of the Most Common Barriers Preventing Women from Accessing Maternal and Newborn Child Health (MNCH) and Prevention of Mother-to-Child Transmission (PMTCT) Services: A Literature Review. AIDS Behav. 2014;18:516–530. doi: 10.1007/s10461-014-0756-5.
    1. United Nations Programme on HIV/AIDS (UNAIDS). The GAP report 2014 [Internet]. Geneva, Switzerland: UNAIDS; 2015. Available from: . Accessed 3 Jan 2017.
    1. World Health Organization . Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV [internet] Geneva, Switzerland: World Health Organization; 2015.
    1. National Population Commission (NPC) [Nigeria], ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, Maryland, USA: National Population Commission (NPC) [Nigeria] and ICF International.; 2014.
    1. Thirumurthy H, Masters SH, Mavedzenge SN, Maman S, Omanga E, Agot K. Promoting male partner HIV testing and safer sexual decision making through secondary distribution of self-tests by HIV-negative female sex workers and women receiving antenatal and post-partum care in Kenya: a cohort study. Lancet HIV. 2016;3:e266–e274. doi: 10.1016/S2352-3018(16)00041-2.
    1. Thirumurthy H, Masters SH, Rao S, Murray K, Prasad R, Zivin JG, et al. The effects of providing fixed compensation and lottery-based rewards on uptake of medical male circumcision in Kenya: a randomized trial. J Acquir Immune Defic Syndr. 2016;72(Suppl 4):S299–S305.
    1. Wilson N, Frade S, Rech D, Friedman W. Advertising for demand creation for voluntary medical male circumcision. J Acquir Immune Defic Syndr. 2016;72:S293–S296. doi: 10.1097/QAI.0000000000001039.
    1. Thorgeirsson T, Kawachi I. Behavioral economics: merging psychology and economics for lifestyle interventions. Am J Prev Med. 2013;44:185–189. doi: 10.1016/j.amepre.2012.10.008.
    1. de Walque D, Dow WH, Nathan R, Abdul R, Abilahi F, Gong E, et al. Incentivising safe sex: a randomised trial of conditional cash transfers for HIV and sexually transmitted infection prevention in rural Tanzania. BMJ Open. 2012;2:e000747. doi: 10.1136/bmjopen-2011-000747.
    1. Glassman A, Duran D, Fleisher L, Singer D, Sturke R, Angeles G, et al. Impact of conditional cash transfers on maternal and newborn health. J Health Popul Nutr. 2013;31:S48–S66.
    1. Taylor NK, Buttenheim AM. Improving utilization of and retention in PMTCT services: can behavioral economics help? BMC Health Serv Res. 2013;13:406. doi: 10.1186/1472-6963-13-406.
    1. Friedman W, Wilson N. Money, Masculinity, and Men’s Health: Experimental Evidence on Demand for a Preventive Health Input [Internet]. Reed College Working Paper; 2017 [cited 2017 Aug 3]. Available from: . Accessed 3 Aug 2017.
    1. Akwa Ibom State Ministry of Health, FHI 360, and UNAIDS. Operational Plan for the Elimination of Mother-to-Child Transmission of HIV [Internet]. Akwa Ibom: Akwa Ibom State Ministry of Health, FHI 360, and UNAIDS; 2013. Available from: . Accessed 3 Jan 2017.
    1. Flax VL, Hamela G, Mofolo I, Hosseinipour MC, Hoffman IF, Maman S. Factors influencing postnatal option B+ participation and breastfeeding duration among HIV-positive women in Lilongwe District, Malawi: A qualitative study. PLOS ONE. 2017;12:e0175590. doi: 10.1371/journal.pone.0175590.
    1. Chan AK, Kanike E, Bedell R, Mayuni I, Manyera R, Mlotha W, et al. Same day HIV diagnosis and antiretroviral therapy initiation affects retention in Option B+ prevention of mother-to-child transmission services at antenatal care in Zomba District, Malawi. J Int AIDS Soc. 2016;19:20672.
    1. Buregyeya E, Naigino R, Mukose A, Makumbi F, Esiru G, Arinaitwe J, et al. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth. 2017;17:94. doi: 10.1186/s12884-017-1276-x.
    1. Nyondo AL, Choko AT, Chimwaza AF, Muula AS. Invitation cards during pregnancy enhance male partner involvement in prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV) in Blantyre, Malawi: A Randomized Controlled Open Label Trial. PLOS ONE. 2015;10:e0119273. doi: 10.1371/journal.pone.0119273.
    1. Kakimoto K, Kanal K, Mukoyama Y, Chheng TV, Chou TL, Sedtha C. Influence of the involvement of partners in the mother class with voluntary confidential counselling and testing acceptance for prevention of mother to child transmission of HIV Programme (PMTCT Programme) in Cambodia. AIDS Care. 2007;19:381–384. doi: 10.1080/09540120500520998.
    1. Rotheram-Borus MJ, Richter LM, van Heerden A, van Rooyen H, Tomlinson M, Harwood JM, et al. A Cluster Randomized Controlled Trial Evaluating the Efficacy of Peer Mentors to Support South African Women Living with HIV and Their Infants. PLOS ONE. 2014;9:e84867. doi: 10.1371/journal.pone.0084867.
    1. Yotebieng M, Thirumurthy H, Moracco KE, Kawende B, Chalachala JL, Wenzi LK, et al. Conditional cash transfers and uptake of and retention in prevention of mother-to-child HIV transmission care: a randomised controlled trial. Lancet HIV. 2016;3:e85–e93. doi: 10.1016/S2352-3018(15)00247-7.
    1. Baird S, Ferreira FHG, Özler B, Woolcock M. Conditional, unconditional and everything in between: a systematic review of the effects of cash transfer programmes on schooling outcomes. J Dev Eff. 2014;6:1–43. doi: 10.1080/19439342.2014.890362.
    1. Guanais FC. The combined effects of the expansion of primary health care and conditional cash transfers on infant mortality in Brazil, 1998–2010. Am J Public Health. 2015;105:S593–S599. doi: 10.2105/AJPH.2013.301452r.
    1. Okoli U, Morris L, Oshin A, Pate MA, Aigbe C, Muhammad A. Conditional cash transfer schemes in Nigeria: potential gains for maternal and child health service uptake in a national pilot programme. BMC Pregnancy Childbirth. 2014;14:408. doi: 10.1186/s12884-014-0408-9.
    1. Ministère du Plan et Suivi de la Mise en oeuvre de la Révolution de la Modernité (MPSMRM), Ministère de la Santé Publique (MSP), ICF International. Enquête Démographique et de Santé en République Démocratique du Congo 2013–2014. Rockville, Maryland, USA: MPSMRM, MSP et ICF International; 2014.
    1. Mugo PM, Wahome EW, Gichuru EN, Mwashigadi GM, Thiong’o AN, Prins HAB, et al. Effect of text message, phone call, and in-person appointment reminders on uptake of repeat HIV testing among outpatients screened for acute HIV infection in Kenya: a randomized controlled trial. PLoS One. 2016;11:e0153612. doi: 10.1371/journal.pone.0153612.
    1. Bigna JJR, Noubiap JJN, Kouanfack C, Plottel CS, Koulla-Shiro S. Effect of mobile phone reminders on follow-up medical care of children exposed to or infected with HIV in Cameroon (MORE CARE): a multicentre, single-blind, factorial, randomised controlled trial. Lancet Infect Dis. 2014;14:600–608. doi: 10.1016/S1473-3099(14)70741-8.
    1. Erlwanger AS, Joseph J, Gotora T, Muzunze B, Orne-Gliemann J, Mukungunugwa S, et al. Patterns of HIV Care Clinic Attendance and Adherence to Antiretroviral Therapy Among Pregnant and Breastfeeding Women Living With HIV in the Context of Option B+ in Zimbabwe. J Acquir Immune Defic Syndr. 1999;75(Suppl 2):S198–S206.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅