Role of Temporal Discounting in a Conditional Cash Transfer (CCT) Intervention to Improve Engagement in the Prevention of Mother-to-Child Transmission (PMTCT) Cascade

Abstract

Background: Temporal discounting (TD), 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 TD on health behaviors. We hypothesized that CCTs work by mitigating the effects of high TD, measured using a delay-discounting task.Methods: We conducted an interaction analysis using data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services.Results: The effect of TD on retention was small, and we did not observe evidence of interaction between TD and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high TD on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: -0.09, 0.44).Conclusions: Our findings support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high TD.CONTRIBUTIONS TO THE LITERATURE· Conditional cash transfer (CCT) interventions demonstrate varying degrees of effectiveness in improving engagement in HIV care. Understanding how these interventions work allow for better adaptation in different contexts, though few studies have explored the underlying mechanisms of CCT.· We assessed whether CCT works by mitigating the effect of temporal discounting on disengagement from care, a major posited mechanism of the intervention, among HIV infected pregnant and breastfeeding women in the Democratic Republic of Congo. · Our findings contribute to gaps in literature surrounding the role of temporal discounting, and its mitigation by CCT, on engagement in HIV care.

Applying Behavioural Insights to HIV Prevention and Management: a Scoping Review

“…Other examples include text-based ART medication reminders and mindfulness exercises to reduce HIV viral load (Table 2). Culturally relevant and gender-specific messaging to engage in HIV prevention [30,101] Loss framed lottery intervention to encourage dual contraception methods to prevent HIV infection [86] HIV to take PrEP medication [142] HIV management Use of priming stimuli that is empowering or culturally meaningful to improve adherence to ART and retention in care [143,144] Use of financial rewards as priming to improve adherence to ART and to suppress viral load count [49,145] Providing safe sex materials as priming to practice safe sex to prevent HIV transmission [146] Personalised cues and reminder messages for remembering dose times to support ART adherence [72,74,147,148] Affect HIV prevention Creating positive emotion for HIV testing or accessing HIV services [111,139,149,150] Peer-led group sessions to learn skills for self-efficacy and positive sexual health behaviours [31] Increasing risk perception towards HIV to encourage HIV prevention behaviours [99,151] HIV management Creating positive emotion for HIV care retention and ART adherence through social, financial, or non-financial support [99,111,143,146] Group sessions targeting positive affect to increase skills for self-efficacy to encourage ART adherence and viral load suppression [146,[152][153][154] Motivational messages to encourage ART adherence [147,150,155] Commitment HIV prevention Use of binding contracts with financial deposits to encourage HIV testing or clinic visits [139,[156]…”