Yotebieng Marcel, Thirumurthy Harsha, Moracco Kathryn E, Edmonds Andrew, Tabala Martine, Kawende Bienvenu, Wenzi Landry K, Okitolonda Emile W, Behets Frieda
*Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH; Departments of †Epidemiology; ‡Health Policy and Management; §Health Behavior, The University of North Carolina at Chapel Hill, Chapel Hill, NC; ‖The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo; and ¶Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Acquir Immune Defic Syndr. 2016 Aug 1;72 Suppl 2(Suppl 2):S124-9. doi: 10.1097/QAI.0000000000001062.
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.
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.
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.
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.
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.
需要新的策略来提高预防母婴传播艾滋病（PMTCT）服务的留存率。我们最近发现，以按时就诊为条件的小额、递增现金转移支付可提高PMTCT各环节的留存率。然而，接受激励前来就诊的女性对抗逆转录病毒药物（ARV）的依从性是否与未接受激励的女性相同尚不清楚。
确定接受激励以维持治疗的HIV感染女性在产后6周对抗逆转录病毒治疗的依从性是否与未接受激励但同样维持治疗的女性相同，以及病毒抑制水平是否相同。
在刚果民主共和国金沙萨的产前保健诊所招募妊娠≤32周的新诊断HIV感染女性。将女性按1:1比例随机分为干预组或对照组。干预组在按时就诊并接受所提供的PMTCT服务的条件下可获得补偿（5美元，每次后续就诊额外增加1美元），而对照组接受常规护理。比较两组在产后6周维持治疗、完全依从（每次就诊服用所有药物）或病毒载量不可检测的参与者比例。
在433名随机分组的女性中（干预组216名，对照组217名），332名（76.7%）在产后6周维持治疗，其中干预组174名（80.6%），对照组158名（72.8%），（P = 0.04）。297名参与者（89.5%）有服药计数数据，干预组156名（89.7%），对照组141名（89.2%）；干预组和对照组分别有69.9%（109/156）和68.1%（96/141）完全依从[风险差异，0.02；95%可信区间：-0.06至0.09]。干预组和对照组分别有171名（98.3%）和155名（98.7%）女性有病毒载量结果；干预组66.1%（113/171）和对照组69.7%（108/155）的病毒载量不可检测（风险差异，-0.04；95%可信区间：-0.14至0.07）。在调整婚姻状况、年龄、教育程度、基线CD4计数、病毒载量、孕周和初始抗逆转录病毒治疗方案后，结果相似。
虽然向HIV感染的孕妇提供现金激励可提高产后6周的治疗留存率，但在维持治疗的人群中，研究组之间对抗逆转录病毒药物的依从性和病毒学抑制情况并无差异。
