Conditional Cash Transfers to Increase Retention in PMTCT Care, Antiretroviral Adherence, and Postpartum Virological Suppression: A Randomized Controlled Trial.
Conditional Cash Transfers to Increase Retention in PMTCT Care, Antiretroviral Adherence, and Postpartum Virological Suppression: A Randomized Controlled Trial.
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有条件现金转移以提高预防母婴传播护理、抗逆转录病毒治疗依从性和产后病毒学抑制的保留率：一项随机对照试验。
DOI：
10.1097/qai.0000000000001062
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发表时间：
2016
期刊：
影响因子：
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通讯作者：
Behets,Frieda
中科院分区：
文献类型：
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作者：
Yotebieng,Marcel;Thirumurthy,Harsha;Moracco,KathrynE;Edmonds,Andrew;Tabala,Martine;Kawende,Bienvenu;Wenzi,LandryK;Okitolonda,EmileW;Behets,Frieda
背景：需要新的策略来提高预防母婴艾滋病毒传播（PMTCT）服务的保留率。我们最近表明，以参加诊所为条件的小额增量现金转移支付导致沿着PMTCT级联增加了保留。然而，是否妇女谁收到的激励措施，参加诊所访问的坚持抗逆转录病毒药物（ARV）的那些谁不unknowed.Objective：为了确定是否艾滋病毒感染的妇女谁收到的激励措施，以保持在护理坚持抗逆转录病毒治疗，并取得了相同的病毒抑制水平，在产后6周的那些谁没有收到激励措施，但也保持在care.Methods：新诊断的艾滋病毒感染的妇女在≤ 32周胎龄被招募在产前保健诊所在金沙萨，刚果。妇女以1：1的比例随机分配到干预组或对照组。干预组接受补偿（5美元，加上1美元的增量在每次后续访问）的条件下参加预定的诊所访问和接受提供的PMTCT服务，而对照组接受常规护理。参与者的比例仍然在照顾，完全遵守（采取所有的药丸在每次访问）或无法检测到的病毒载量在产后6周进行了比较跨group.Results：在433名妇女随机（216干预组和217对照组），332（76.7%）仍然在照顾产后6周，其中包括174（80.6%）在干预组和158（72.8%）在对照组，（P= 0.04）。297名参与者（89.5%）的药丸计数数据可用，其中干预组和对照组分别为156名（89.7%）和141名（89.2%）;干预组和对照组中69.9%（109/156）和68.1%（96/141）的患者完全依从[风险差异，0.02; 95%CI：-0.06至0.09]。干预组和对照组分别有171名（98.3%）和155名（98.7%）妇女的病毒载量结果;干预组66.1%（113/171）和对照组69.7%（108/155）的病毒载量检测不到（风险差异，-0.04; 95%CI：-0.14至0.07）。调整后的婚姻状况，年龄，教育，基线CD 4计数，病毒载量，胎龄，和初始ARV regiment.Conclusions：虽然提供现金奖励艾滋病毒感染的孕妇导致更高的保留在产后6周的护理，在那些保留在护理，坚持抗逆转录病毒药物和病毒抑制没有不同的研究组。
Background:Novel strategies are needed to increase retention in prevention of mother-to-child HIV transmission (PMTCT) services. We have recently shown that small, incremental cash transfers conditional on attending clinic resulted in increased retention along the PMTCT cascade. However, whether women who receive incentives to attend clinic visits are as adherent to antiretrovirals (ARV) as those who do not was unknown.Objective:To determine whether HIV-infected women who received incentives to remain in care were as adherent to antiretroviral treatment and achieved the same level of viral suppression at 6 weeks postpartum as those who did not receive incentives but also remained in care.Methods:Newly diagnosed HIV-infected women at≤ 32 weeks gestational age were recruited at antenatal care clinics in Kinshasa, Democratic Republic of Congo. Women were randomized in a 1: 1 ratio to an intervention or control group. The intervention group received compensation ($5, plus $1 increment at each subsequent visit) conditional on attending scheduled clinic visits and accepting offered PMTCT services, whereas the control group received usual care. The proportion of participants who remained in care, were fully adherent (took all their pills at each visit) or with undetectable viral load at 6 weeks postpartum were compared across group.Results:Among 433 women randomized (216 in intervention group and 217 in control group), 332 (76.7%) remained in care at 6 weeks postpartum, including 174 (80.6%) in the intervention group and 158 (72.8%) in the control group,(P= 0.04). Data on pill count were available for 297 participants (89.5%), including 156 (89.7%) and 141 (89.2%) in the intervention and control groups, respectively; 69.9%(109/156) and 68.1%(96/141) in the intervention and control groups had perfect adherence [risk difference, 0.02; 95% CI:− 0.06 to 0.09]. Viral load results were available for 171 (98.3%) and 155 (98.7%) women in the intervention and control groups, respectively; 66.1%(113/171) in the intervention group and 69.7%(108/155) in the control group had an undetectable viral load (risk difference,− 0.04; 95% CI:− 0.14 to 0.07). Results were similar after adjusting for marital status, age, education, baseline CD4 count, viral load, gestational age, and initial ARV regimen.Conclusions:Although the provision of cash incentives to HIV-infected pregnant women led to higher retention in care at 6 weeks postpartum, among those retained in care, adherence to ARVs and virologic suppression did not differ by study group.