Jessica Londeree Saleska1,2, Abigail Norris Turner3, Maria F Gallo4, Abigail Shoben4, Bienvenu Kawende5, Noro Lantoniaina Rosa Ravelomanana4,5, Harsha Thirumurthy6,7, Marcel Yotebieng8. 1. Division of Epidemiology, Cunz Hall, The Ohio State University, College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA. jsaleska@mednet.ucla.edu. 2. The University of California Los Angeles, Global Center for Children and Families, Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd, Los Angeles, CA, 90024, USA. jsaleska@mednet.ucla.edu. 3. Division of Infectious Disease, Doan Hall, The Ohio State University, College of Medicine, 410 W. 10th Avenue, Columbus, OH, 43210, USA. 4. Division of Epidemiology, Cunz Hall, The Ohio State University, College of Public Health, 1841 Neil Avenue, Columbus, OH, 43210, USA. 5. The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of Congo. 6. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA. 7. Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, USA. 8. Department of Medicine, Division of General Internal Medicine, Albert Einstein College of Medicine, 3300 Kossuth Ave, Bronx, NY, 10467, USA.
Abstract
BACKGROUND: Temporal discounting, 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 high discount rates on health behaviors. METHODS: With data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo, we used binomial models to assess interactions between discount rates (measured using a delay-discounting task) and the intervention. 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 high discount rates on retention was small, and we did not observe evidence of interaction between high discount rates and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high discount rates on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: - 0.09, 0.44). CONCLUSIONS: Our findings provide evidence to support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high rates of temporal discounting. TRIAL REGISTRATION: Clinicaltrials.gov number NCT01838005 , April 23, 2013.
RCT Entities:
BACKGROUND: Temporal discounting, 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 high discount rates on health behaviors. METHODS: With data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo, we used binomial models to assess interactions between discount rates (measured using a delay-discounting task) and the intervention. 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 high discount rates on retention was small, and we did not observe evidence of interaction between high discount rates and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high discount rates on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: - 0.09, 0.44). CONCLUSIONS: Our findings provide evidence to support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high rates of temporal discounting. TRIAL REGISTRATION: Clinicaltrials.gov number NCT01838005 , April 23, 2013.
Entities:
Keywords:
HIV; Intertemporal preferences; PMTCT Cascade; Prevention of mother-to-child transmission of HIV (PMTCT); Temporal discounting
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