Acceptability and feasibility of a financial incentive intervention to improve retention in HIV care among pregnant women in Johannesburg, South Africa

ABSTRACT

Women initiating antiretroviral therapy during pregnancy are at high risk of dropping out of HIV care after delivery. We assessed the acceptability and feasibility of a financial incentive – a one-time R50 (∼USD4) supermarket voucher for completing one postpartum visit ≤10 weeks of delivery – to improve postpartum retention. We enrolled 100 pregnant, HIV-positive women at a primary health clinic in Johannesburg, South Africa. Participants were interviewed at enrollment and we reviewed files to assess retention ≥14 weeks postpartum. Median (IQR) respondent age was 28 years (24–31) and 31% were employed. Most (86%) said the incentive would motivate them to return and 76% supported clinics offering incentives. Among the 23% who found the intervention unacceptable, the most frequent reason was perceived personal responsibility for health. Feasibility was demonstrated, as 79.7% (51/64) of eligible participants received a voucher. When asked to rank preferred hypothetical incentive interventions, assistance with social services ranked first (29%), followed by infant formula (22%) and cash (21%); assistance with social services was the top-ranked choice by both those who found the voucher incentive intervention acceptable and unacceptable. To encourage HIV-positive women to remain in care, respondents most frequently suggested health education (34%), counseling (29%), financial incentives (25%), home visits (13%), and better service (6%). Our results suggest financial incentives are acceptable, but women frequently expressed preference for integrated services and improved education and counseling to improve retention. Interventions exploring the feasibility and efficacy of education and counseling interventions to improve postpartum HIV care are warranted.

KEYWORDS:

• HIV/AIDS
• prevention of mother-to-child transmission of HIV (PMTCT)
• continuum of care
• financial incentive
• pregnant women
• South Africa

Acknowledgments

The authors are grateful to the patients and staff of the study clinic, operated by the City of Johannesburg, for their participation in this study. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, USAID or the US Government.

Meetings

This work will be presented as a poster presentation at the 9th International AIDS Conference in Paris, France, in July 2017.

Registry information

This study is registered as NCT02351362 on ClinicalTrials.gov.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kate Clouse http://orcid.org/0000-0002-0190-7398

Additional information

Funding

This work was supported through a crowdfunding effort at Boston University. Dr. Clouse was supported by the National Institute of Mental Health of the National Institutes of Health under [Award Number K01MH107256] and through an Ann Potter Wilson Family Foundation Award at Vanderbilt University Medical Center. HE²RO staff were supported by the United States Agency for International Development (USAID) under Cooperative [Agreement AID 674-A-12-00029].