Global Health and Population Research, Durham, North Carolina, United States of America.
Global Education, Employment, and Engagement, Washington, District of Columbia, United States of America.
PLoS One. 2021 Jul 30;16(7):e0252083. doi: 10.1371/journal.pone.0252083. eCollection 2021.
Economic strengthening (ES) interventions can address economic barriers to retention and adherence (R&A) to antiretroviral therapy in prevention of mother-to-child transmission (PMTCT) services. To inform tailoring of ES activities for PMTCT, we used financial diaries to understand the economic lives of women in PMTCT and examine associations between participants' finances and their R&A.
We collected financial data from a stratified sample (n = 241) of HIV-positive pregnant women and new mothers enrolled in PMTCT from three clinics in Zomba, Malawi. For 30 weeks, participants met with staff to record cash and in-kind inflows and outflows. We used clinical records to calculate a measure of R&A for each participant. We summarized diary data using R and used cox proportional hazard models to examine the relationship between R&A and participant characteristics and behavior.
There were 68,097 cash transactions over 30 weeks, with 10% characterized as inflows. The median value of cash inflows was US$3.54 compared with US$0.42 for cash outflows. Fewer than 7% of total transactions were considered related to PMTCT, with the majority classified as food or drink. Participants in the rural site had the lowest hazard of non-adherence. Decreased hazard of non-adherence was also linked to having dependents and years on ART. There were significant differences in cash inflows and outflows between those who were always adherent and those who were not.
Financial inflows were large and erratic, whereas outflows were small but consistent. PMTCT expenses comprised a small proportion of overall expenses and focused on proper nutrition. The influence of inflows and outflows on adherence was significant but small; however, always adherent participants demonstrated smoother inflows and outflows, indicating an association between greater adherence and economic stability. Participants would benefit from interventions that bolster and stabilize their economic lives, including income generating activities in the agricultural industry and inclusion in village banks.
经济强化（ES）干预措施可以解决艾滋病病毒母婴传播（PMTCT）服务中保留和坚持（R&A）抗逆转录病毒治疗的经济障碍。为了为 PMTCT 活动提供定制服务，我们使用财务日记来了解 PMTCT 中妇女的经济生活，并研究参与者的财务状况与他们的 R&A 之间的关系。
我们从马拉维宗巴的三个诊所招募了分层样本（n=241）的 HIV 阳性孕妇和新妈妈，收集了他们的财务数据。在 30 周的时间里，参与者与工作人员一起记录现金和实物的流入和流出。我们使用临床记录为每个参与者计算了一个 R&A 指标。我们使用 R 总结日记数据，并使用 Cox 比例风险模型检查 R&A 与参与者特征和行为之间的关系。
在 30 周内共进行了 68097 次现金交易，其中 10%被归类为流入。现金流入的中位数为 3.54 美元，而现金流出的中位数为 0.42 美元。不到 7%的总交易被认为与 PMTCT 有关，其中大部分被归类为食品或饮料。农村地区的参与者的非依从性风险最低。非依从性的风险降低也与有家属和接受抗逆转录病毒治疗的年限有关。在始终坚持和不坚持的参与者之间，现金流入和流出存在显著差异。
现金流入量很大且不稳定，而流出量很小但稳定。PMTCT 支出仅占总支出的一小部分，重点是适当的营养。流入量和流出量对依从性的影响显著但较小；然而，始终坚持的参与者表现出更平稳的流入和流出，这表明更大的依从性与经济稳定性之间存在关联。参与者将受益于增强和稳定其经济生活的干预措施，包括农业行业的创收活动和参与村庄银行。
