Effectiveness of conditional cash transfers for uptake and retention in HIV prevention of mother-to-child transmission services in low- and middle-income countries: A systematic review and meta-analysis

OBJECTIVE: The objective of this systematic review was to synthesize the best available evidence on the effectiveness of conditional cash transfers for the uptake and retention in prevention of mother-to-child transmission (PMTCT) services among pregnant and/or breastfeeding women with HIV in low- and middle-income countries (LMICs). INTRODUCTION: Regardless of the effectiveness of PMTCT services, uptake and retention in such services remains low in LMICs. Conditional cash transfers are considered an important strategy to improve the uptake of preventive services in pregnant women and children. This review evaluated the effectiveness of conditional cash transfers for improving uptake and retention in PMTCT services for pregnant and/or breastfeeding women with HIV infection. ELIGIBILITY CRITERIA: Eligible studies that compared the impact of conditional cash transfers on uptake and retention in PMTCT services with standard care or with another intervention among pregnant and/or breastfeeding women with HIV. The primary outcomes were retention and uptake in PMTCT programs, reported as the percentage of pregnant and/or breastfeeding women with HIV enrolled in antiretroviral therapy and the number of facility-based deliveries. The secondary outcomes included the percentage of infants completing postexposure HIV testing at 4 to 6 weeks after birth or early infant diagnosis; the percentage of infants exposed to HIV who tested positive for HIV; and the percentage of infants exposed to HIV with health defects (eg, neural tube defects, heart defects, major limb malformations). METHODS: This review was conducted in line with the JBI methodology for systematic reviews of effectiveness. Databases searched included the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase (Ovid), and CINAHL (EBSCOhost). Sources of unpublished studies/gray literature included ProQuest Dissertations and Theses, OpenGrey, WHO International Clinical Trials Registry Platform, and ClinicalTrials.gov. Studies published in English since 2000 were considered. The JBI Critical Appraisal Checklist for Randomized Controlled Trials was used to assess the methodological quality of the included studies. Data were extracted from the included studies and the studies were pooled in a statistical meta-analysis. Effect sizes were presented as odds ratios (ORs) and CIs (95%) were calculated. The standard IØ 2 and I2 tests were used to assess heterogeneity statistically. Statistical analyses were conducted using fixed effects based on established guidance. RESULTS: Two randomized controlled studies were included in this review with a total of 950 participants. Two outcomes were pooled and assessed for the effects of conditional cash transfers: facility-based delivery and early infant diagnosis of HIV. Conditional cash transfers have a significant positive effect on both outcomes compared to standard care. The OR for facility-based delivery was 1.53 (95% CI, 1.15–2.04; P =0.004) and the OR for early infant diagnosis was 1.89 (95% CI, 1.38–2.59; P <0.001). Heterogeneity ( I2 ) was 0% for facility-based delivery and 30% for early infant diagnosis. CONCLUSION: This review summarizes the available evidence on the effectiveness of conditional cash transfers for the uptake and retention in PMTCT services among pregnant and/or breastfeeding women with HIV in LMICs. It is possible that conditional cash transfers increase facility-based delivery and may increase early infant diagnosis of HIV. REVIEW REGISTRATION: PROSPERO CRD42021236729.

• Population(s)
  • Women
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Retention in care
  • Treatment
• Prevention
  • Biomedical interventions
• Health Systems
  • Governance arrangements
  • Financial arrangements
  • Delivery arrangements