Conditional cash transfers to prevent mother-to-child transmission in low facility-delivery settings: evidence from a randomised controlled trial in Nigeria

January 23, 2019
Authors: Jenny X. Liu, Jennifer Shen, Nicholas Wilson, Svetha Janumpalli, Patrick Stadler and Nancy Padian
Organization: BMC Pregnancy and Childbirth

Preventing HIV transmission from mother to child is possible, but it requires adherence to many steps in the prevention-of-mother-to-child (PMTCT) cascade.  Nigeria has one of the highest rates of transmission to newborns with 1 in 3 children born with HIV being born in Nigeria.  The government of Nigeria has scaled up provision of PMTCT services, yet uptake has remained low.

In this randomized control trial, pregnant women testing positive for HIV during antenatal care registration at three public hospitals were randomized to one of two study arms: (1) offered enrollment into the conditional cash transfer program or (2) continue in standard care for PMTCT. In the conditional cash transfer arm, women could receive a compensation package totaling 33,300 Naira (~US$114) for fulfilling three obligations (1) enrolling (2) delivering at the facility, and (3) obtaining a newborn early infant diagnosis (EID) test.

Results showed large effects in conditional cash transfers improving the likelihood of HIV-positive women giving birth at a facility, of nevirapine being administered to their newborn, and of undergoing EID testing.  While the study results suggest that conditional cash transfers can increase retention in care for PMTCT in Akwa Ibom, Nigeria, nearly 60% of women still did not opt to deliver at a facility or obtain an EID test for their infant after birth.  The results suggest that financial incentives may be one promising strategy, but it may need to be investigated further or combined with other incentives to fully improve retention in care.