有条件现金转移通过减轻没钱前往诊所的负面影响来提高预防母婴传播服务的留存率。
Conditional Cash Transfers Improve Retention in PMTCT Services by Mitigating the Negative Effect of Not Having Money to Come to the Clinic.
作者信息
Yotebieng Marcel, Moracco Kathryn E, Thirumurthy Harsha, Edmonds Andrew, Tabala Martine, Kawende Bienvenu, Wenzi Landry K, Okitolonda Emile W, Behets Frieda
机构信息
*Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH; Departments of †Epidemiology; ‡Health Behavior; §Health Policy and Management, The University of North Carolina at Chapel Hill, Chapel Hill, NC; ‖School of Public Health, The University of Kinshasa, Kinshasa, Democratic Republic of Congo; and ¶Department of Social Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
出版信息
J Acquir Immune Defic Syndr. 2017 Feb 1;74(2):150-157. doi: 10.1097/QAI.0000000000001219.
OBJECTIVE
To elucidate the mechanisms by which a cash incentive intervention increases retention in prevention of mother-to-child transmission services.
METHODS
We used data from a randomized controlled trial in Kinshasa, Democratic Republic of Congo. Perceptual factors associated with loss to follow-up (LTFU) through 6 weeks postpartum were first identified. Then, binomial models were used to assess interactions between LTFU and identified factors, and the cash incentive intervention.
RESULTS
Participants were less likely to be LTFU if they perceived HIV as a "very serious" health problem for their baby vs. not [risk difference (RD), -0.13; 95% confidence interval (CI): -0.30 to 0.04], if they believed it would be "very likely" to pass HIV to their baby if they did not take any HIV drug vs. not (RD, -0.15; 95% CI: -0.32 to 0.02), and if they anticipated that not having money would make it difficult for them to come to the clinic vs. not (RD, 0.12; 95% CI: -0.07 to 0.30). The effect of each of the 3 factors on LTFU was antagonistic to that of receiving the cash incentive intervention. The excess risk due to interaction between the cash incentive intervention and the anticipated difficulty of "not having money" to come to the clinic was exactly equal to the effect of removing this perceived barrier (excess risk due to interaction, -0.12; 95% CI: -0.35 to 0.10).
CONCLUSIONS
Our analyses show that cash transfers improve retention in prevention of mother-to-child transmission services mainly by mitigating the negative effect of not having money to come to the clinic.
目的
阐明现金激励干预措施提高预防母婴传播服务留存率的机制。
方法
我们使用了刚果民主共和国金沙萨一项随机对照试验的数据。首先确定与产后6周失访相关的感知因素。然后，使用二项式模型评估失访与已确定因素以及现金激励干预之间的相互作用。
结果
如果参与者认为艾滋病毒对其婴儿来说是“非常严重”的健康问题，而非不这样认为（风险差异[RD]，-0.13；95%置信区间[CI]：-0.30至0.04），如果他们认为如果不服用任何抗艾滋病毒药物，“很有可能”会将艾滋病毒传染给婴儿，而非不这样认为（RD，-0.15；95%CI：-0.32至0.02），以及如果他们预计没钱会使他们难以前来诊所，而非不这样认为（RD，0.12；95%CI：-0.07至0.30），那么他们失访的可能性较小。这三个因素中的每一个对失访的影响都与接受现金激励干预的影响相反。现金激励干预与预计“没钱”前来诊所的困难之间相互作用导致的额外风险，恰好等于消除这种感知障碍的影响（相互作用导致的额外风险，-0.12；95%CI：-0.35至0.10）。
结论
我们的分析表明，现金转移主要通过减轻没钱前来诊所的负面影响，提高了预防母婴传播服务的留存率。
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