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Temporal Discounting and the Prevention of Mother to Child Transmission (PMTCT) of HIV among Pregnant and Breastfeeding Women in the Democratic Republic of Congo

Londeree, Jessica K
http://orcid.org/0000-0002-2733-724X
http://rave.ohiolink.edu/etdc/view?acc_num=osu1546428369119761

Abstract Details

2019, Doctor of Philosophy, Ohio State University, Public Health.
Introduction: Lifelong treatment for HIV-infected women offers profound benefits in terms of the prevention of mother-to-child transmission of HIV (PMTCT) and disease management, though poor adherence to antiretroviral drugs (ARV) and disengagement from PMTCT care can jeopardize these benefits. Insights from the field of behavioral economics reveal that high temporal discounting can lead to risky health behaviors, and these findings have informed the development of interventions, such conditional cash transfers (CCT), to mitigate these effects. Few studies, however, have directly assessed the effects of temporal discounting on behaviors relating to HIV prevention and treatment, and none have evaluated these effects among pregnant and breastfeeding women. Further, few studies have assessed the role of temporal discounting on the effect CCT or other similar interventions providing conditional economic incentives to improve behaviors relating to HIV treatment and prevention. Methods: We conducted a secondary analysis of data from a randomized controlled trial (RCT) conducted in Kinshasa, the Democratic Republic of Congo, which assessed the effect of a CCT intervention on retention in PMTCT care, adherence to ARV and viral suppression among newly-diagnosed HIV-infected pregnant women. We identified correlates of temporal discounting from health and demographic information collected at baseline. We then assessed the association between temporal discounting and retention in care at 6 weeks postpartum, uptake of available PMTCT services, and viral suppression at 6 weeks postpartum using log-binomial models to calculate unadjusted and adjusted RRs for high vs. low discounting for each outcome. We also evaluated possible interaction between temporal discounting and CCT for each outcome (retention, uptake of available PMTCT services and viral suppression). Results: High temporal discounting was associated with incomplete uptake of PMTCT services, and this effect was mitigated by CCT contingent upon retention in care and uptake of PMTCT services. Moreover, temporal discounting was associated with reduced odds of viral suppression at 6 weeks postpartum, through this effect was not mitigated by CCT. Conclusions: Effective solutions to maintain proper adherence and engagement in PMTCT care are critical to sustain program effectiveness and viral suppression, which reduces the risk of maternal death, mother-to-child transmission of HIV (MTCT), as well as the development of drug resistance. Our results indicate that women with high temporal discounting represent a critical target population for interventions to improve adherence and engagement in care. Future research should explore how the choice of incentivized behavior may affect the efficacy of CCT, and alternative approaches to mitigate the harmful effects of temporal discounting on PMTCT-related outcomes.
Abigail Norris Turner, PhD (Advisor)
Maria Gallo, PhD (Committee Member)
Abigail Shoben, PhD (Committee Member)
Marcel Yotebieng, PhD, MD (Committee Member)
99 p.
Economics; Epidemiology; Psychology; Public Health
Temporal Discounting; Intertemporal Preferences; HIV; Prevention of Mother-to-Child Transmission; PMTCT; Reproductive Health

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Citations

  • Londeree, J. K. (2019). Temporal Discounting and the Prevention of Mother to Child Transmission (PMTCT) of HIV among Pregnant and Breastfeeding Women in the Democratic Republic of Congo [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1546428369119761

    APA Style (7th edition)

  • Londeree, Jessica. Temporal Discounting and the Prevention of Mother to Child Transmission (PMTCT) of HIV among Pregnant and Breastfeeding Women in the Democratic Republic of Congo. 2019. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1546428369119761.

    MLA Style (8th edition)

  • Londeree, Jessica. "Temporal Discounting and the Prevention of Mother to Child Transmission (PMTCT) of HIV among Pregnant and Breastfeeding Women in the Democratic Republic of Congo." Doctoral dissertation, Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1546428369119761

    Chicago Manual of Style (17th edition)

osu1546428369119761
352
© 2019, some rights reserved.Creative Commons License Temporal Discounting and the Prevention of Mother to Child Transmission (PMTCT) of HIV among Pregnant and Breastfeeding Women in the Democratic Republic of Congo by Jessica K Londeree is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License. Based on a work at etd.ohiolink.edu.
This open access ETD is published by The Ohio State University and OhioLINK.