Role of Temporal Discounting in a Conditional Cash Transfer (CCT) Intervention to Improve Engagement in the Prevention of Mother-to-child Transmission (PMTCT) Cheaascade

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Abstract Background: Temporal discounting (TD), 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 TD on health behaviors. We hypothesized that CCTs work by mitigating the effects of high TD, measured using a delay-discounting task. Methods: We conducted an interaction analysis using data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo. 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 TD on retention was small, and we did not observe evidence of interaction between TD and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high TD on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: -0.09, 0.44). Conclusions: Our findings support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high TD.

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